Reduction of Computed Tomography Use for Pediatric Closed Head Injury Evaluation at a Nonpediatric Community Emergency Department

Puffenbarger, Melissa S.; Ahmad, Fahd A.; Argent, Michelle; Gu, Hongjie; Samson, Charles M.; Quayle, Kimberly S.; Saito, Jacqueline M.

doi:10.1111/acem.13666

Cited by 26 publications

(23 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Both had either general paediatricians in the hospital34 or PEM physicians in the ED,35 allowing inhouse or direct clinical support, and were affiliated with an academic children’s hospital, a resource lacking in smaller community hospitals across the country. A third study, by Puffenbarger et al 36 showed a decrease in HCT rate of 20.8% in a community ED (preintervention HCT rate of 37.7% and postintervention HCT rate of 16.9%). Similar to our community ED, there was no inhouse paediatric support.…”

Section: Discussionmentioning

confidence: 95%

“…Three studies have engaged community EDs using QI and successfully reduced HCT rates 34–36. Two of the studies34 35 provided Maintenance of Certification for participating physicians.…”

Section: Discussionmentioning

confidence: 99%

“…Similar to our community ED, there was no inhouse paediatric support. Trauma designation was not provided in the above studies 34–36…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Reduction of paediatric head CT utilisation at a rural general hospital emergency department

et al. 2020

View full text Add to dashboard Cite

BackgroundBlunt head injury is a common pediatric injury and often evaluated in general emergency departments. It estimated that 50% of children will undergo a head computed tomography (CT), often unnecessarily exposing the child to ionizing radiation. Pediatric academic centers have shown quality improvement (QI) measures can reduce head CT rates within their emergency departments. We aimed to reduce head CT utilization at a rural community emergency department.MethodsChildren presenting with a complaint of blunt head injury and were evaluated with or without a head CT. Head CT rate was the primary outcome. We developed a series of interventions and presented these to the general emergency department over the duration of the study. The pre and intervention data was analysed with control charts.ResultsThe preintervention and intervention groups consisted of 576 children: 237 patients with a median age of 8.0 years and 339 patients with a median age of 9.00 years (p=0.54), respectively. The preintervention HCT rate was 41.8% (95% CI 35.6% to 48.1%) and the postintervention rate was 27.7% (95% CI 23.3% to 32.7%), a decrease of 14.1% (95% CI 6.2% to 21.9%, p=0.0004). During the intervention period, there was a decrease in HCT rate of one per month (OR 0.96, 95% CI 0.92 to 1.00, p=0.07). The initial series of interventions demonstrated an incremental decrease in HCT rates corresponding with a special cause variation.ConclusionThe series of interventions dispersed over the intervention period was an effective methodology and successfully reduced HCT utilisation among children with blunt head injury at a rural community emergency department.

show abstract

Section: Discussionmentioning

confidence: 95%

“…Three studies have engaged community EDs using QI and successfully reduced HCT rates 34–36. Two of the studies34 35 provided Maintenance of Certification for participating physicians.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Reduction of paediatric head CT utilisation at a rural general hospital emergency department

et al. 2020

View full text Add to dashboard Cite

show abstract

“…13,15 This finding is particularly concerning as community hospitals provide the majority of pediatric emergency care. 16–18…”

Section: Introductionmentioning

confidence: 99%

Reducing the Cranial CT Rate for Pediatric Minor Head Trauma at Three Community Hospitals

Smith

Gruskin

Monuteaux

et al. 2019

Pediatric Quality &Amp; Safety

View full text Add to dashboard Cite

Objective: Efforts to reduce the rate of computerized cranial tomography (CT) in pediatric patients with minor head trauma (MHT) have focused on academic medical centers. However, community hospitals deliver the majority of pediatric emergency care. We aimed to reduce cranial CT utilization in patients presenting with MHT at 3 community hospital emergency departments (EDs). Methods: Multidisciplinary stakeholder teams at each site oversaw the quality improvement effort, which included education about an evidence-based guideline for MHT and individual provider feedback on CT rates. Given the variation in hospital structure, we tailored the specifics of the intervention to each site. We used statistical process control methodology to measure CT rates over time. The primary balancing measure was returned to the ED within 72 hours with clinically important traumatic brain injury. Results: We included 3,215 pediatric ED visits for MHT: 1,253 in the baseline period and 1,962 in the intervention period. The CT rate dropped from 18% in the baseline period to 13% in the intervention period, a 28% relative reduction. Pediatric providers saw 72% of the intervention period encounters and drove this reduction. There was no increase in the number of children who returned to their local ED within 72 hours with clinically important traumatic brain injury. Conclusions: We safely reduced the proportion of children with MHT who received a cranial CT through a multicenter community ED quality improvement initiative. We did not see an increase in missed clinically important traumatic brain injury.

show abstract

“…Intermediate‐risk MHI patients pose a challenge, because the rules recommend either CT or ED observation (based on clinical presentation and provider/parental preference). Implementation of PECARN rules in combination with clinical decision support systems and provider feedback has successfully reduced CT rates for all‐risk MHI patients in both pediatric and community EDs 7–9,11,12 . Moving forward, the intermediate‐risk MHI patients provide a challenging opportunity for improvement because CT scan utilization in this group remains high.…”

mentioning

confidence: 99%

Reducing Computed Tomography Scan Utilization for Pediatric Minor Head Injury in the Emergency Department: A Quality Improvement Initiative

Arora

White

Niedbala

et al. 2020

Academic Emergency Medicine

View full text Add to dashboard Cite

Background The validated Pediatric Emergency Care Applied Research Network (PECARN) prediction rules are meant to aid clinicians in safely reducing unwarranted imaging in children with minor head injuries (MHI). Even so, computed tomography (CT) scan utilization remains high, especially in intermediate‐risk (per PECARN) MHI patients. The primary objective of this quality improvement initiative was to reduce CT utilization rates in the intermediate‐risk MHI patients. Methods This project was conducted in a Level I trauma pediatric emergency department (ED). Children < 18 years evaluated for intermediate‐risk MHI from June 2016 through July 2019 were included. Our key drivers were provider education, decision support, and performance feedback. Our primary outcome was change in head CT utilization rate (%). Balancing measures included return visit within 72 hours of the index visit, ED length of stay (LOS), and clinically important traumatic brain injury (ciTBI) on the revisit. We used statistical process control methodology to assess head CT rates over time. Results A total of 1,535 eligible intermediate‐risk MHI patients were analyzed. Our intervention bundle was associated with a decrease in CT use from 18.5% (95% confidence interval [CI] = 14.5% to 22.5%) in the preintervention period to 13.9% (95% CI = 13.8% to 14.1%) in the postintervention period, an absolute reduction of 4.6% (p = 0.015). Over time, no difference was noted in either ED LOS or return visit rate. There was only one revisit with a ciTBI to our institution during the study period. Conclusions Our multifaceted quality improvement initiative was both safe and effective in reducing our CT utilization rates in children with intermediate‐risk MHI.

show abstract

Reduction of Computed Tomography Use for Pediatric Closed Head Injury Evaluation at a Nonpediatric Community Emergency Department

Cited by 26 publications

References 21 publications

Reduction of paediatric head CT utilisation at a rural general hospital emergency department

Reduction of paediatric head CT utilisation at a rural general hospital emergency department

Reducing the Cranial CT Rate for Pediatric Minor Head Trauma at Three Community Hospitals

Reducing Computed Tomography Scan Utilization for Pediatric Minor Head Injury in the Emergency Department: A Quality Improvement Initiative

Contact Info

Product

Resources

About