RESUMEN
The decision as to whether to perform a computed tomography (CT) examination in severe pediatric trauma poses a challenge. The therapeutic benefit of computed tomography in injured children is lower compared to adults, while the potential negative effects of ionizing radiation may be higher. Thus, the threshold for CT should be higher. Centers that less frequently treat pediatric cases tend to conduct more whole-body CT examinations than dedicated pediatric trauma centers, indicating a clinical overestimation of injury severity with subsequently unnecessary imaging due to inexperience. On the other hand, a CT scan that is not performed but is actually necessary can also have negative consequences if an injury is detected with a delay. An injured child presents a challenging situation for all involved healthcare providers, and thus requires a structured approach to decision-making.Selective literature review of the benefits and risks of CT in injured children, as well as indications for whole-body and region-specific CT imaging.This article provides an overview of current guidelines, recent insight into radiation protection and the benefits of CT in injured children, and evidence-based decision criteria for choosing the appropriate modality based on the mechanism of injury and the affected body region. · Whole-body CT has less of an influence on treatment decisions and mortality in severely injured children than in adults.. · For radiation protection reasons, the indication should be determined more conservatively in children than in adult trauma patients.. · The indication for CT should ideally be determined separately for each region of the body.. · Ultrasound and MRI are a good alternative for the primary diagnostic workup in many situations.. · Appelhaus S, Schönberg SO, Weis M. CT in pediatric trauma patients. Fortschr Röntgenstr 2024; DOI 10.1055/a-2341-7559.
RESUMEN
BACKGROUND: Disclosure of items used in multiple-choice-question (MCQ) exams may decrease student anxiety and improve transparency, feedback, and test-enhanced learning but potentially compromises the reliability and fairness of exams if items are eventually reused. Evidence regarding whether disclosure and reuse of test items change item psychometrics is scarce and inconclusive. METHODS: We retrospectively analysed difficulty and discrimination coefficients of 10,148 MCQ items used between fall 2017 and fall 2019 in a large European medical school in which items were disclosed from fall 2017 onwards. We categorised items as 'new'; 'reused, not disclosed'; or 'reused, disclosed'. For reused items, we calculated the difference from their first ever use, that is, when they were new. Differences between categories and terms were analysed with one-way analyses of variance and independent-samples t tests. RESULTS: The proportion of reused, disclosed items grew from 0% to 48.4%; mean difficulty coefficients increased from 0.70 to 0.76; that is, items became easier, P < .001, ηp2 = 0.011. On average, reused, disclosed items were significantly easier (M = 0.83) than reused, not disclosed items (M = 0.71) and entirely new items (M = 0.66), P < .001, ηp2 = 0.087. Mean discrimination coefficients increased from 0.21 to 0.23; that is, item became slightly more discriminating, P = .002, ηp2 = 0.002. CONCLUSIONS: Disclosing test items provides the opportunity to enhance feedback and transparency in MCQ exams but potentially at the expense of decreased item reliability. Discrimination was positively affected. Our study may help weigh advantages and disadvantages of using previously disclosed items.
