We have developed a guideline for the evaluation of children <2 years old with minor HT. The effect of these guidelines on clinical outcomes and resource utilization should be evaluated.

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Clinical signs of brain injury are insensitive indicators of ICI in infants. A substantial fraction of infants with ICI will be detected through radiographic imaging of otherwise asymptomatic infants with significant scalp hematomas. Asymptomatic infants older than 3 months of age who have no significant scalp hematoma may be safely managed without radiographic imaging.

Among asymptomatic head-injured infants, the risk of SF and associated ICI is correlated with scalp hematoma size, hematoma location, and weakly with patient age. We propose a clinical decision rule that could identify most cases of SF and ICI while not requiring head imaging for most patients. This decision rule should be validated in other study populations.

Objectives: To identify patient, provider, and hospital characteristics associated with the use of neuroimaging in the evaluation of head trauma in children. Methods: This was a cross-sectional study of children (≤19 years of age) with head injuries from the National Hospital Ambulatory Medical Care Survey (NHAMCS) collected by the National Center for Health Statistics. NHAMCS collects data on approximately 25,000 visits annually to 600 randomly selected hospital emergency and outpatient departments. This study examined visits to U.S. emergency departments between 2002 and 2006. Multivariable logistic regression was used to analyze characteristics associated with neuroimaging in children with head injuries. Results: There were 50,835 pediatric visits in the 5 year sample, of which 1,256 (2.5%, 95% CI = 2.2% to 2.7%) were for head injury. Among these, 39% (95% CI = 34% to 43%) underwent evaluation with neuroimaging. In multivariable analyses, factors associated with neuroimaging included white race (odds ratio [OR] 1.5, 95% CI = 1.02 to 2.1), older age (OR 1.3, 95% CI = 1.1 to 1.5), presentation to a general hospital (vs. a pediatric hospital, OR 2.4, 95% CI = 1.1 to 5.3), more emergent triage status (OR 1.4, 95% CI = 1.1 to 1.8), admission or transfer (OR 2.7, 95% CI = 1.4 to 5.3), and treatment by an attending physician (OR 2.0, 95% CI = 1.1 to 3.7). The effect of race was mitigated at the pediatric hospitals compared to at the general hospitals (p < 0.001). Conclusions: In this study, patient race, age, and hospital-specific characteristics were associated with the frequency of neuroimaging in the evaluation of children with closed head injuries. Based on these results, focusing quality improvement initiatives on physicians at general hospitals may be an effective approach to decreasing rates of neuroimaging after pediatric head trauma.

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