Variation in Computed Tomography Use for Evaluation of Head Injury in a Pediatric Emergency Department

Abstract

Physicians at our pediatric hospital ED varied in the use of CT for the evaluation of head-injured children.

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

“…This finding differs from several other studies where either no association was found between rate of injury and CTB use or imaging variation persisted even after accounting for injury prevalance . Physician background and training was not collected as part of this study but has been associated with differential scanning rates in other studies . Furthermore, while access to, and clinician comfort with, admission or observation in Australia and New Zealand as an alternative to immediate CTB may explain differences between our rates and those noted internationally, there was no consistent relationship between LOS ≥4 h and CTB rates across sites.…”

“…In our cohort, this group had a lower rate of CTB use and a lower admission rate. Lower scan rates have been noted elsewhere, although this has not been universally reported . The lower scan rate in this group may be driven by concerns about the age related lifetime cancer risks with radiation exposure .…”

“…Differences in age and sex of presenting populations were explored. Children under 2 years of age were considered as a separate subgroup given previously reported differences in the management of younger children across sites . CTB rates were also considered in the context of injury severity, as defined by the presence of ciTBI and abnormal CTBs, to account for possible site differences in the prevalence of more severe injuries.…”

“…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.…”