Comparison of minor head trauma management in the emergency departments of a United States and Italian Children’s hospital

Abstract

BackgroundPediatric head trauma management varies between emergency departments globally. Here we aim to compare the pediatric minor head trauma management between a US and Italian hospital.MethodsWe conducted a retrospective chart review of children 0–18 years old presenting after minor head trauma (Glasgow Coma Scale 14–15) from two emergency departments, in Boston, Massachusetts, United States and Trieste, Italy, between January and December 2013. Frequencies of demographic, clinical, and management characteristic were calculated. We compared rate ratios for characteristics of patients receiving cranial computed tomography (CT) scans between the two populations.ResultsThere were 1783 patients in Boston, Massachusetts and 183 patients in Trieste, Italy. Patients in Boston had more reported neurologic symptoms (61.2%) than in Trieste (6%) (p < 0.001). More CT scans were ordered on the patients in Boston (17.3% vs. 6.6%) (p < 0.001), while more children were hospitalized in Trieste (55.7% vs. 8.6%) (p < 0.001). Patients with neurological symptoms more commonly had a CT scan in Trieste (45.5%) than in Boston (23.5%) (RR 0.52, 95% CI 0.27, 1.00), while more patients without neurological symptoms had CTs in Boston (7.5%) than in Trieste (4.1%) (RR 1.85, 95% CI 0.86, 4.00). Assignment of triage levels and definitions of head injury severity varied considerably between the two hospitals, resulting in dissimilar populations presenting to the two hospitals, and thus, differences in the management of these children.ConclusionThe population of head trauma patients and the management of pediatric minor head trauma differs between Boston and Trieste, with a preference for CT scans in Boston and a preference for hospitalization in Trieste. Clinical guidelines used at each institution likely lead to this variation in care influenced by the different patient populations and institutional resources.

The Evaluation of Patients Admitted due to Minor Head Trauma with Clinical Decision Rules

“…When the literature was reviewed, in a study in which the multicenter PECARN rules were applied, this rate was 7%, [8] and in a study in which a pediatric hospital in the United States of America and Italy was compared, the CT rates of patients admitted due tominorhead traumawere 17.3% and 6.6%, respectively. [9] In another study, the CT rate of patients admitted to a pediatric trauma center due to minor head trauma was %94.6. [10] As seen in the literature, CT ratescan notably vary according to countries, clinics, and that the clinical decision rules are not used sufficiently.…”

Canadian infants presenting with Brief Resolved Unexplained Events (BRUEs) and validation of clinical prediction rules for risk stratification: a protocol for a multicentre, retrospective cohort study

“…No large studies to date have assessed the BRUE population outside of the USA, particularly since the publication of the new 2016 AAP guidelines. Previous reports targeting bronchiolitis, gastroenteritis or traumatic brain injuries have identified variability in the rate of admissions and diagnostic testing between the USA and other countries, particularly Canada 13–18. As such, studies conducted in different healthcare settings are required to generalise the findings observed by the BRUE-QIRC.…”