Variation in CT use for paediatric head injuries across different types of emergency departments in Australia and New Zealand

Abstract

ObjectivesCT of the brain (CTB) for paediatric head injury is used less frequently at tertiary paediatric emergency departments (EDs) in Australia and New Zealand than in North America. In preparation for release of a national head injury guideline and given the high variation in CTB use found in North America, we aimed to assess variation in CTB use for paediatric head injury across hospitals types.MethodsMulticentre retrospective review of presentations to tertiary, urban/suburban and regional/rural EDs in Australia and New Zealand in 2016. Children aged <16 years, with a primary ED diagnosis of head injury were included and data extracted from 100 eligible cases per site. Primary outcome was CTB use adjusted for severity (Glasgow Coma Scale) with 95% CIs; secondary outcomes included hospital length of stay and admission rate.ResultsThere were 3072 head injury presentations at 31 EDs: 9 tertiary (n=900), 11 urban/suburban (n=1072) and 11 regional/rural EDs (n=1100). The proportion of children with Glasgow Coma Score ≤13 was 1.3% in each type of hospital. Among all presentations, CTB was performed for 8.2% (95% CI 6.4 to 10.0) in tertiary hospitals, 6.6% (95% CI 5.1 to 8.1) in urban/suburban hospitals and 6.1% (95% CI 4.7 to 7.5) in regional/rural. Intragroup variation of CTB use ranged from 0% to 14%. The regional/rural hospitals admitted fewer patients (14.6%, 95% CI 12.6% to 16.9%, p<0.001) than tertiary and urban/suburban hospitals (28.1%, 95% CI 25.2% to 31.2%; 27.3%, 95% CI 24.7% to 30.1%).ConclusionsIn Australia and New Zealand, there was no difference in CTB use for paediatric patients with head injuries across tertiary, urban/suburban and regional/rural EDs with similar intragroup variation. This information can inform a binational head injury guideline.

Factors predictive for computed tomography use and abnormality in paediatric head injuries in Australia and New Zealand

“…Clinicians may have a higher threshold to conduct a CTB in younger children driven by concerns about radiation and the need for sedation. As in our previous study, 5 type of hospital did not drive differences in CTB rates.…”

“…Clinicians may have a higher threshold to conduct a CTB in younger children driven by concerns about radiation and the need for sedation. As in our previous study, 5 type of hospital did not drive differences in CTB rates. Although the overall patient numbers were large and the percentage of abnormal CTB was relatively high, the CTB scanning rate across centres was low and the number of abnormal scans was low, which limits deeper analysis.…”

“…This study was a planned secondary analysis of a multicentre retrospective study of paediatric head injury presentations to 31 EDs in 2016 5 . EDs were stratified to tertiary, urban/suburban and regional/rural hospital types.…”

“…However, most children with head injuries present to mixed, non‐tertiary EDs, where variation in CTB rates has been reported in North America 2–4 . In a study including all types of EDs in Australia and New Zealand, hospital type was not associated with CTB use rates 5 . Here we set out to determine patient‐level factors associated with ordering a CTB and having an abnormal CTB.…”

“…[2][3][4] In a study including all types of EDs in Australia and New Zealand, hospital type was not associated with CTB use rates. 5 Here we set out to determine patient-level factors associated with ordering a CTB and having an abnormal CTB.…”