Imaging infants with head injury: effect of a change in policy

Browning, J; Reed, Matthew J; Wilkinson, A G; Beattie, T F

doi:10.1136/emj.2004.016196

Cited by 16 publications

(14 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Of the titles and abstracts screened, 12 relevant full papers were retrieved and assessed in detail. 21,22,37,136,[152][153][154][155][156][157][158][159] One RCT 37 comparing immediate CT during triage with observation in hospital for patients with MHI fulfilled the inclusion criteria. A flow chart describing the process of identifying relevant literature can be found in Appendix 7.…”

Section: Studies Included In the Reviewmentioning

confidence: 99%

“…data presented as structured tables with a narrative description, but without a formal quality assessment). The two contemporaneous cohort studies 152,153 compared alternative hospital admission policies, whereas nine uncontrolled before/after studies 21,22,136,[154][155][156][157][158][159] evaluated the effect of introducing guidelines for head injury management. A summary of the study and patient characteristics is presented in Table 23.…”

Section: Additional Evidencementioning

confidence: 99%

“…Two papers from the same UK paediatric teaching hospital evaluated the effect of a policy change to restrict the use of skull radiography in infants 154 and children 136 with a head injury presenting to the ED between 1998-9 and 2002-3. Abandoning the use of skull radiography in children aged between 1 and 14 years did not lead to a significant increase in admission rates (10.1% vs 10.9%; p = 0.43), missed ICI (0.20% vs 0.37%; p = 0.53) or neurosurgical intervention (0% vs 0.1%; p = 0.30), but doubled the proportion of children who received a CT scan from 1.0% to 2.1% (p = 0.02).…”

Section: Cohort Studiesmentioning

confidence: 99%

“…136 Limitation of skull radiography in infants led to a substantial decrease in skull radiography rates (77.3% to 29.5%; p-value not reported) with no detriment to the infant in terms of missed injury or admissions (13.8% vs 10%; p-value not reported). 154 Loroni et al 157 compared the management of children (≤ 14 years) with head injury (all severities) in an Italian general hospital in two different periods (1984-5 and 1988-90), one before and one after the introduction of a protocol for the management of children with head injury (with indications for hospital admission and diagnostic procedures). The results showed that, among the clinical cases with milder symptoms of head injury, hospital admissions for observation decreased significantly from 40.3% to 27.8% (p < 0.05) and skull radiography from 86.7% to 36.1% (p < 0.05), without an increase in the number of diagnostic errors.…”

Section: Cohort Studiesmentioning

confidence: 99%

See 3 more Smart Citations

Diagnostic management strategies for adults and children with minor head injury: a systematic review and an economic evaluation

Pandor

Goodacre²,

Harnan³

et al. 2011

Health Technol Assess

109

114

View full text Add to dashboard Cite

How to obtain copies of this and other HTA programme reports An electronic version of this title, in Adobe Acrobat format, is available for downloading free of charge for personal use from the HTA website (www.hta.ac.uk). A fully searchable DVD is also available (see below).Printed copies of HTA journal series issues cost £20 each (post and packing free in the UK) to both public and private sector purchasers from our despatch agents.Non-UK purchasers will have to pay a small fee for post and packing. For European countries the cost is £2 per issue and for the rest of the world £3 per issue. How to order:-fax (with credit card details) -post (with credit card details or cheque) -phone during office hours (credit card only).Additionally the HTA website allows you to either print out your order or download a blank order form. Contact details are as follows:Synergie UK (HTA Department) Digital House, The Loddon Centre Wade Road Basingstoke Hants RG24 8QW Email: orders@hta.ac.uk Tel: 0845 812 4000 -ask for 'HTA Payment Services' (out-of-hours answer-phone service) Fax: 0845 812 4001 -put 'HTA Order' on the fax header Payment methods Paying by chequeIf you pay by cheque, the cheque must be in pounds sterling, made payable to University of Southampton and drawn on a bank with a UK address.Paying by credit card You can order using your credit card by phone, fax or post. SubscriptionsNHS libraries can subscribe free of charge. Public libraries can subscribe at a reduced cost of £100 for each volume (normally comprising 40-50 titles). The commercial subscription rate is £400 per volume (addresses within the UK) and £600 per volume (addresses outside the UK). Please see our website for details. Subscriptions can be purchased only for the current or forthcoming volume.How do I get a copy of HTA on DVD?Please use the form on the HTA website (www.hta.ac.uk/htacd/index.shtml). HTA on DVD is currently free of charge worldwide.The website also provides information about the HTA programme and lists the membership of the various committees. HTADiagnostic management strategies for adults and children with minor head injury: a systematic review and an economic evaluation NIHR Health Technology Assessment programmeThe Health Technology Assessment (HTA) programme, part of the National Institute for Health Research (NIHR), was set up in 1993. It produces high-quality research information on the effectiveness, costs and broader impact of health technologies for those who use, manage and provide care in the NHS. 'Health technologies' are broadly defined as all interventions used to promote health, prevent and treat disease, and improve rehabilitation and long-term care. The research findings from the HTA programme directly influence decision-making bodies such as the National Institute for Health and Clinical Excellence (NICE) and the National Screening Committee (NSC). HTA findings also help to improve the quality of clinical practice in the NHS indirectly in that they form a key component of the 'National Knowledge Service' . The HTA...

show abstract

Section: Studies Included In the Reviewmentioning

confidence: 99%

Section: Additional Evidencementioning

confidence: 99%

Section: Cohort Studiesmentioning

confidence: 99%

Section: Cohort Studiesmentioning

confidence: 99%

See 2 more Smart Citations

Diagnostic management strategies for adults and children with minor head injury: a systematic review and an economic evaluation

Pandor

Goodacre²,

Harnan³

et al. 2011

Health Technol Assess

109

114

View full text Add to dashboard Cite

show abstract

“…Through the literature review, we found 14 independent variables associated with an increased risk of skull fracture. 4,5,20,22,[26][27][28][29][30][31][32] The variables were related to demographic characteristics (age and sex); the accident (e.g., height of the fall, high-velocity impact, type of surface, fall from parent's arms or with the parent); the patient's symptoms (e.g., crying more than usual, bleeding, decrease in eating, hypotonia); and findings on physical examination (e.g., swelling or hematoma [consistency, width, localization], number and length of lacerations and pain on examination). The potential independent variables are listed in Appendix 1 (available at www.cmaj.ca/ lookup/suppl/doi:10.1503/cmaj.150540/-/DC1).…”

Section: Standardized Assessment Of Patientsmentioning

confidence: 99%