Pediatric Head Trauma: Changes in Use of Computed Tomography in Emergency Departments in the United States Over Time

Blackwell, Charles D.; Gorelick, Marc H.; Holmes, James F.; Bandyopadhyay, Sivaji; Kuppermann, Nathan

doi:10.1016/j.annemergmed.2006.09.025

Cited by 183 publications

(141 citation statements)

References 9 publications

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“…This is similar to the findings of other authors (15)(16). Still, we found a relatively high rate and alarming growth in CT use among children and adults, knowing that this age group is more vulnerable to harmful effects of radiation.…”

Section: Agesupporting

confidence: 83%

Demographic changes in brain CT and MRI between 1990 and 2010

Vancauwenberghe¹,

Demaerel²

2013

Journal of the Belgian Society of Radiology

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Study objective: During the last decades, computed tomography and magnetic resonance imaging have revolutionized neuro-imaging. Nowadays these techniques are routinely used, but the extent and variation of use has been investigated poorly. Our purposes were to retrospectively determine the evolution in demographic variables and indications of cranial CT and MRI scanning in 1993, 2000 and 2009, at our hospital. Methods: We retrospectively studied medical and neurologic in-and outpatients, who underwent CT-or MR imaging of the head for several demographic and patient characteristics. Results: We observed a modest increase in mean age and a marked increase in total number of cranial CT examinations, MR confirmation studies and repeat examinations. Metastatic disease, head injury and headache were indications associated with more rapid growth in CT use than were others. Conclusion: Among the 5 patient and hospital factors considered (total number of examinations, age, indication, MR confirmation study and repeat examinations), all had a significant variation during the past 16 years. Strict regulations with compelling guidelines for the rational use of brain CT and MRI are inevitable in order to control expenditure and radiation exposure.

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Section: Agesupporting

confidence: 83%

Demographic changes in brain CT and MRI between 1990 and 2010

Vancauwenberghe¹,

Demaerel²

2013

Journal of the Belgian Society of Radiology

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“…More than 260,000 CT scans are performed for evaluation of blunt head trauma in children annually in U.S. emergency departments (EDs), with a great deal of practice variation. 4,5 A clinical decision rule in the setting of pediatric blunt head trauma could reduce both variation in practice and unnecessary CT scans. Such decision rules have helped optimize testing in the setting of adult head trauma, 6 ankle injuries, 7 and febrile illness.…”

mentioning

confidence: 99%

Interobserver Agreement in Assessment of Clinical Variables in Children with Blunt Head Trauma

Gorelick

Atabaki

Hoyle

et al. 2008

Academic Emergency Medicine

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Objectives: To be useful in development of clinical decision rules, clinical variables must demonstrate acceptable agreement when assessed by different observers. The objective was to determine the interobserver agreement in the assessment of historical and physical examination findings of children undergoing emergency department (ED) evaluation for blunt head trauma.Methods: This was a prospective cohort study of children younger than 18 years evaluated for blunt head trauma at one of 25 EDs in the Pediatric Emergency Care Applied Research Network (PECARN). Patients were excluded if injury occurred more than 24 hours prior to evaluation, if neuroimaging was obtained at another hospital prior to evaluation, or if the patient had a clinically trivial mechanism of injury. Two clinicians independently completed a standardized clinical assessment on a templated data form. Assessments were performed within 60 minutes of each other and prior to clinician review of any neuroimaging (if obtained). Agreement between the two observers beyond that expected by chance was calculated for each clinical variable, using the kappa (j) statistic for categorical variables and weighted kappa for ordinal variables. Variables with a lower 95% confidence limit (LCL) of j > 0.4 were considered to have acceptable agreement.Results: Fifteen-hundred pairs of observations were obtained. Acceptable agreement was achieved in 27 of the 32 variables studied (84%). Mechanism of injury (low, medium, or high risk) had j = 0.83. For subjective symptoms, kappa ranged from 0.47 (dizziness) to 0.93 (frequency of vomiting); all had 95% LCL > 0.4. Of the physical examination findings, kappa ranged from 0.22 (agitated) to 0.89 (Glasgow Coma Scale [GCS] score). The 95% LCL for kappa was <0.4 for four individual signs of altered mental status and for quality (i.e., boggy or firm) of scalp hematoma if present.Conclusions: Both subjective and objective clinical variables in children with blunt head trauma can be assessed by different observers with acceptable agreement, making these variables suitable candidates for clinical decision rules.

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“…The most prominent finding in this study was the dramatic decrease in CT use for injured children treated after PTC designation, even when controlling for patient and injury specific variables. Current literature underscores the overuse of CT scans for injured children [19][20][21] and the link between CT use in the pediatric population and overall increased lifetime risk of cancer [22,23]. In response, multiple triage algorithms emphasizing monitored observation, plain radiography and decreased CT usage have been developed [24][25][26].…”

Section: Discussionmentioning

confidence: 99%

Academic-community partnerships improve outcomes in pediatric trauma care

Kelley-Quon¹,

Crowley²,

Applebaum³

et al. 2015

Journal of Pediatric Surgery

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a b s t r a c t a r t i c l e i n f oBackground: To address the specialized needs of injured children, pediatric trauma centers (PTCs) were established at many large, academic hospitals. This study explores clinical outcomes observed for injured children treated at an academic-sponsored community facility. Methods: In partnership with an academic medical center in a major metropolitan area, a not-for-profit community hospital became a designated Level II PTC in October 2010. Data for injured children b15 years old treated prior to PTC designation from January 2000 to September 2010 were prospectively collected using the Trauma and Emergency Medicine Information System and compared to data collected after PTC designation from January 2011 to December 2013. Results: Overall, 681 injured children were treated at the community hospital from January 2011 to December 2013. Children treated after PTC designation were less likely to undergo computed tomography (CT) (50.9% vs. 81.3%, p b 0.01), even when controlling for age, gender, injury type, injury severity, and year (OR 0.18, 95%CI 0.08-0.37). Specifically, fewer head (45.7% vs. 68.7%, p b 0.01) and abdominal CTs (13.2% vs. 26.5%, p b 0.01) were performed. Hospital length of stay was significantly shorter (2.8 ± 3.7 days vs. 3.7 ± 5.9 days, p b 0.01). Mortality was low overall, but also decreased after PTC designation (0.4% vs. 2.0%, p = 0.02). Conclusions: These results indicate that academic-community partnerships in pediatric trauma care are a feasible alternative and may lead to improved outcomes for injured children.

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Pediatric Head Trauma: Changes in Use of Computed Tomography in Emergency Departments in the United States Over Time

Cited by 183 publications

References 9 publications

Demographic changes in brain CT and MRI between 1990 and 2010

Demographic changes in brain CT and MRI between 1990 and 2010

Interobserver Agreement in Assessment of Clinical Variables in Children with Blunt Head Trauma

Academic-community partnerships improve outcomes in pediatric trauma care

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