Effect of the Duration of Emergency Department Observation on Computed Tomography Use in Children With Minor Blunt Head Trauma

Schonfeld, Deborah; Fitz, Brianna M.; Nigrovic, Lise E.

doi:10.1016/j.annemergmed.2013.06.020

Cited by 60 publications

(50 citation statements)

References 21 publications

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“…24 Observation has previously been associated with a time-dependent reduction in CT rate 25 and has been suggested for the management of minor blunt head trauma in the AAP Choosing Wisely campaign. 8 We had expected ED length of stay for children with minor blunt head trauma to increase over the implementation period as more clinicians used observation rather than immediate CT. Interestingly, ED length of stay for children with minor blunt head trauma decreased slightly from the pre- to postimplementation periods, suggesting that the institutional head trauma QI initiative allowed for more efficient care delivery for children with minor blunt head trauma.…”

Section: Discussionmentioning

confidence: 99%

Quality Improvement Effort to Reduce Cranial CTs for Children With Minor Blunt Head Trauma

Nigrovic¹,

Stack²,

Mannix³

et al. 2015

Pediatrics

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OBJECTIVE Blunt head trauma is a common injury in children, although it rarely requires surgical intervention. Cranial computed tomography (CT) is the reference standard for the diagnosis of traumatic brain injury but has been associated with increased lifetime malignancy risk. We implemented a multifaceted quality improvement initiative to decrease the use of cranial CT for children with minor head injuries. METHODS We designed and implemented a quality improvement effort that included an evidence-based guideline as well as individual feedback for children aged 0 to 21 years who present to the emergency department (ED) for evaluation of minor blunt head trauma. Our primary outcome was cranial CT rate, and our balancing measure was any return to the ED within 72 hours that required hospitalization. We used statistical process control methodology to measure cranial CT rates over time. RESULTS We included 6851 ED visits of which 4242 (62%) occurred in the post–guideline implementation period. From a baseline CT rate of 21%, we observed an absolute reduction of 6% in cranial CT rate (95% confidence interval 3% to 9%) after initial guideline implementation and an additional absolute reduction of 6% (95% confidence interval 4% to 8%) after initiation of individual provider feedback. No children discharged from the ED required admission within 72 hours of initial evaluation. CONCLUSIONS An ED quality improvement effort that included an evidence-based guideline as well as individual provider feedback was associated with a reduction in cranial CT rates without an increase in missed significant head injuries.

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Section: Discussionmentioning

confidence: 99%

Quality Improvement Effort to Reduce Cranial CTs for Children With Minor Blunt Head Trauma

Nigrovic¹,

Stack²,

Mannix³

et al. 2015

Pediatrics

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“…Another prospective study with 1,306 children with mild TBI demonstrated that 49% of subjects were observed in the ED, and 20% underwent CT scans [134]. After adjusting for time from injury, patient age, gender, physician type, and study month, every additional hour of ED observation time was associated with a commensurate decrease in the CT rate for children in all risk groups (evidence level II).…”

Section: Which Pediatric Patients With Tbi Can Safely Avoidmentioning

confidence: 99%

Imaging Evidence and Recommendations for Traumatic Brain Injury: Conventional Neuroimaging Techniques

Wintermark

Sanelli

Anzai

et al. 2015

Journal of the American College of Radiology

152

118

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“…For children who are not at very low risk, observation can also be an important management strategy, allowing selective CT use for those children whose symptoms progress or fail to improve during the period of observation. Observation has been associated with a significant reduction in cranial CT rate with no change in rate of clinically important TBI 17 18. Importantly, children with significant head injuries very rarely have delayed presentations (more than 4–6 h after injury),19 mitigating the risk of missing a significant TBI when clinicians choose to observe a child prior to CT decision making.…”

Section: Discussionmentioning

confidence: 99%

Republished: Pediatric Emergency Care Applied Research Network head injury clinical prediction rules are reliable in practice

Schonfeld

Bressan

Dalt

et al. 2015

Postgraduate Medical Journal

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Effect of the Duration of Emergency Department Observation on Computed Tomography Use in Children With Minor Blunt Head Trauma

Cited by 60 publications

References 21 publications

Quality Improvement Effort to Reduce Cranial CTs for Children With Minor Blunt Head Trauma

Quality Improvement Effort to Reduce Cranial CTs for Children With Minor Blunt Head Trauma

Imaging Evidence and Recommendations for Traumatic Brain Injury: Conventional Neuroimaging Techniques

Republished: Pediatric Emergency Care Applied Research Network head injury clinical prediction rules are reliable in practice

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