Use of CT for Head Trauma: 2007–2015

Burstein, Brett; Upton, Julia; Terra, Heloisa Fuzaro; Neuman, Mark I.

doi:10.1542/peds.2018-0814

Cited by 53 publications

(53 citation statements)

References 36 publications

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“…Among those with a CT scan, 0.9% had ciTBI, defined as any of the following caused by TBI: death, receipt of neurosurgery, intubation >24 hours, or hospital admission >2 days associated with TBI on CT. Although Burstein et al 1 found a similar CT rate (32%), the current study hospital admission rate was only 2%, revealing a sustained use of CT scans despite apparently, on average, less severely injured patients compared with patients in the earlier PECARN cohort.…”

contrasting

confidence: 52%

“…In this month's Pediatrics, Burstein et al 1 report disappointing statistics in their work entitled "Use of CT for Head Trauma: 2007-2015." Using the National Hospital Ambulatory Medical Care Survey, a representative data set for emergency department (ED) visits, 2 they found that 32% of pediatric patients presenting for head trauma had computed tomography (CT) imaging as part of their evaluation.…”

mentioning

confidence: 99%

“…Additionally, they reported that ∼90% of US children received their trauma care at general (nonteaching and nonchildren's) hospitals, where CT use was higher. 1 Some history regarding CT use for pediatric head injury is helpful. In 1999, the American Academy of Pediatrics reviewed treatment of minor head injury and divided recommended evaluation and treatment by whether there was brief loss of consciousness (LOC).…”

mentioning

confidence: 99%

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Trends in Pediatric Head CT Use: Looking Beyond the Ivory Tower

Coon

Bratton

2018

Pediatrics

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contrasting

confidence: 52%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Trends in Pediatric Head CT Use: Looking Beyond the Ivory Tower

Coon

Bratton

2018

Pediatrics

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“…These community EDs thus hugely impact the care of pediatric patients nationwide. Previously published reports demonstrate that CTs are more frequently obtained in low‐ and intermediate‐risk head‐injured children by physicians with emergency medicine training compared to pediatric training and in nonteaching, suburban, and nonfreestanding children's hospitals . It follows that implementation of pediatric best‐practice guidelines such as the PECARN head injury decision tool within community EDs may have a large, positive impact on pediatric emergency care.…”

mentioning

confidence: 99%

Reduction of Computed Tomography Use for Pediatric Closed Head Injury Evaluation at a Nonpediatric Community Emergency Department

Puffenbarger

Ahmad²,

Argent³

et al. 2019

Academic Emergency Medicine

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Objective: The purpose of this study was to determine if implementation of a Pediatric Emergency Care AppliedResearch Network (PECARN)-based Closed Head Injury Assessment Tool could safely decrease computed tomography (CT) use for pediatric head injury evaluation at a nonpediatric community emergency department (ED).Methods: A quality improvement project was initiated at a nonpediatric community ED to implement an institution-specific, PECARN-based Pediatric Closed Head Injury Assessment Tool. Baseline head CT use at the participating ED was determined for children with closed head injury through retrospective chart review from March 2014 through November 2015. Head injury patients were identified using International Classification of Disease (ICD)-9 codes for head injury, unspecified (959.01) and concussion with and without loss of consciousness (850-850.9) until October 2015, after which ICD-9 was no longer used. To identify eligible patients after October 2015, lists of all pediatric patients evaluated at the participating ED were reviewed, and patients were included in the analysis if they had a physician-assigned discharge diagnosis of head injury or concussion. Exclusion criteria were age ≥ 18 years, penetrating head trauma, history of brain tumor, ventriculoperitoneal shunt, bleeding disorder, or presentation > 24 hours postinjury. Medical history, injury mechanism, symptoms, head CT use, and disposition were recorded. Implementation of the Pediatric Closed Head Injury Assessment Tool was achieved through provider education sessions beginning in December 2015 and ending in August 2016. Head CT use was monitored for 12 months postimplementation, from September 2016 through August 2017. Patients were classified into low, intermediate, or high risk for clinically important traumatic brain injury (ciTBI) by chart review. ED length of stay (LOS), disposition, and ED returns within 72 hours were recorded. Categorical variables were compared using chi-square test or Fisher's exact test, and continuous variables, using Kruskal-Wallis test.Results: A total of 252 children with closed head injury were evaluated preimplementation (. Overall CT use decreased from 37.7% (95% confidence interval [CI] = 31.7-43.7) preimplementation to 16.9% (95% CI = 11.3-22.5) postimplementation (p < 0.001). Only 1% (95% CI = 0%-2.9%) of low-risk patients received a head CT postimplementation compared to 22.6% (95% CI = 16.1%-29.1%) preimplementation (p < 0.001). CT use among patients ≥ 24 months decreased from 42.9% (95% CI = 36.5%-49.6%) to 19.6% (95% CI = 13.1%-26.1%;

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“…A third of children with head injuries presenting to emergency departments in the United States receive imaging 3. The associated radiation risk for an individual child is low, but it becomes important at a population level.…”

mentioning

confidence: 99%