Faculty Collaboration Database

Emergency department practice variation in computed tomography use for children with minor blunt head trauma. J Pediatr 2014 Dec;165(6):1201-1206.e2

Date

10/09/2014

Pubmed ID

25294604

DOI

10.1016/j.jpeds.2014.08.008

Scopus ID

2-s2.0-84912526559 (requires institutional sign-in at Scopus site)   89 Citations

Abstract

OBJECTIVE: To describe factors associated with computed tomography (CT) use for children with minor blunt head trauma that are evaluated in emergency departments.

STUDY DESIGN: Planned secondary analysis of a prospective observational study of children <18 years with minor blunt head trauma between 2004 and 2006 at 25 emergency departments. CT scans were obtained at the discretion of treating clinicians. We risk-adjusted patients for clinically important traumatic brain injuries and performed multivariable regression analyses. Outcome measures were rates of CT use by hospital and by clinician training type.

RESULTS: CT rates varied between 19.2% and 69.2% across hospitals. Risk adjustment had little effect on the differential rate of CT use. In low- and middle-risk patients, clinicians obtained CTs more frequently at suburban and nonfreestanding children's hospitals. Physicians with emergency medicine (EM) residency training obtained CTs at greater rates than physicians with pediatric residency or pediatric EM training. In multivariable analyses, compared with pediatric EM-trained physicians, the OR for CT use among EM-trained physicians in children <2 years was 1.24 (95% CI 1.04-1.46), and for children >2 years was 1.68 (95% CI 1.50-1.89). Physicians of all training backgrounds, however, overused CT scans in low-risk children.

CONCLUSIONS: Substantial variation exists in the use of CT for children with minor blunt head trauma not explained by patient severity or rates of positive CT scans or clinically important traumatic brain injuries.

Author List

Stanley RM, Hoyle JD Jr, Dayan PS, Atabaki S, Lee L, Lillis K, Gorelick MH, Holubkov R, Miskin M, Holmes JF, Dean JM, Kuppermann N, Pediatric Emergency Care Applied Research Network (PECARN)

MESH terms used to index this publication - Major topics in bold

Child
Child, Preschool
Emergency Service, Hospital
Head Injuries, Closed
Hospitals, Pediatric
Hospitals, Teaching
Humans
Infant
Multivariate Analysis
Practice Patterns, Physicians'
Prospective Studies
Risk Assessment
Skull
Tomography, X-Ray Computed