Computed tomography for head injuries in children: Change in Australian usage rates over time

Abstract

CTB use in head injuries did not increase during the study period, and rates of CTB were less than reported for North America.

Imaging and admission practices in paediatric head injury across emergency departments in Australia and New Zealand: A PREDICT study

“…While variation between hospitals, type of ED and country exists, the CTB rate at all sites was less than 20%, with an overall site adjusted rate of 11.2%. Overall imaging rates described in this prospective study are similar to rates described in an earlier retrospective Australasian PREDICT study between 2001 and 2010, suggesting little change over time . Australasian CTB rates are considerably lower and less variable than the paediatric CTB rates described in many other settings; in two large North American cohorts scanning rates across EDs varied between 19 and 58% (overall rate 36%) and 19.2 and 69.2% (35.3%), respectively.…”

“…Overall imaging rates described in this prospective study are similar to rates described in an earlier retrospective Australasian PREDICT study between 2001 and 2010, suggesting little change over time. 13 Australasian CTB rates are considerably lower and less variable than the paediatric CTB rates described in many other settings; in two large North American cohorts scanning rates across EDs varied between 19 and 58% (overall rate 36%) 19 and 19.2 and 69.2% (35.3%), 12 respectively. This latter PECARN study 12 found interhospital variation in the number of CTBs per ciTBI varied between 14.5 and 111.7; in our cohort this ranged from 5.9 to 11.4.…”

“…Imaging practices may have been influenced by the CDR predictor variables collected as part of the parent study. However, among PREDICT site clinicians, no CDR was widely used prior to the APHIRST study and CTB rates were stable over a 10‐year period beginning prior to CDR publication . Admission practices, particularly for the purpose of observation, were also difficult to accurately identify.…”

“…Variation in management practices in paediatric head injury, in particular, the use of neuroimaging, but also of observation and admission, has been described worldwide . These differences often persist within countries and regions, and may vary according to hospital type and individual clinician training background . Australian and New Zealand clinical data indicate a lower rate of CTB use than in North America; however, it is unclear if there is variation of care between hospitals especially when controlling for head injury severity.…”

“…6,11 These differences often persist within countries and regions, and may vary according to hospital type and individual clinician training background. [11][12][13][14] Australian and New Zealand clinical data indicate a lower rate of CTB use than in North America; 6,8,[12][13][14][15] however, it is unclear if there is variation of care between hospitals especially when controlling for head injury severity. Recognising and understanding variation in care may allow opportunities to reduce unwarranted variation and standardise management.…”