A Specialized Pediatric Emergency Medicine Track Decreases Computed Tomography in Head Injured Patients

Abstract

Background There is an increased emphasis on reducing exposure to ionizing radiation in pediatric patients. Guidelines from the Pediatric Emergency Care Applied Research Network help practitioners identify patients at low risk for clinically important traumatic brain injury after head injury. Objectives We seek to determine whether the institution of a pediatric track staffed by pediatric emergency medicine physicians (PEMs) within a community emergency department (ED) impacts the overall utilization of head computed tomography (CT) on children younger than 15 years with head injury. Methods We used a retrospective cohort analysis of patients under the age of 15 years presenting to a community ED in the year before and the year of institution of a pediatric emergency track. Relative risk estimates were used to determine the risk of CT use associated with nonpediatric-trained emergency providers. Results The community ED saw 11,094 patients and 14,639 patients younger than 15 years in fiscal years 2014–2015 and 2015–2016, respectively. In the year before PEMs, there were 312 children younger than 15 years seen for head injury; 47.09% received head CTs. After PEM coverage, there were 396 children younger than 15 years seen for head injury; 17.17% received head CTs. Pediatric patients with head injury were 2.2 times more likely to receive CTs before the institution of the pediatric track (95% confidence interval, 1.8–2.6). Conclusion The implementation of a pediatric emergency track demonstrated a significant decrease in CT utilization for head injury. Continued development of pediatric tracks in community EDs can lead to reduction of CTs.

Risk stratification of intermediate-risk children with minor head injury: a secondary publication translated into Korean

“…적어도 환자가 단층촬영이 불필요한 환자의 유형에 부합하지 않 는다면, PECARN 규칙을 사용해야 한다. 기타 의사 요인을 언급하면, 단층촬영을 자주 처방하는 경향은 응급실 의사가 위험감수성이 약하거나 소아응급의 학 수련을 받지 않은 경우, 또는 진료하는 기관이 이차병원 이거나, 대도시에 위치하지 않거나, 환자수가 적은 경우에 나 타난다 [18][19][20][21] . 이러한 특성은 의사 개인의 경험 및 PECARN 규칙, 또는 소아 경증두부외상 자체에 친숙한 정도와 연관 된 것으로 추정한다.…”