Trends in Head Computed Tomography Utilization in Children Presenting to Emergency Departments After Traumatic Head Injury. Issue 7 (July 2021)

• Record Type: Journal Article
• Authors: Ukwuoma, Onyinyechi I.; Allareddy, Veerajalandhar; Allareddy, Veerasathpurush; Rampa, Sankeerth; Rose, Jerri A.; Shein, Steven L.; Rotta, Alexandre T.
• Is Part Of: Pediatric emergency care. Volume 37:Issue 7(2021)
• Publication Date: 2021-07
• Subjects: computed tomography -- closed head injury -- traumatic brain injury; Pediatric emergencies -- Periodicals; 618.92002505
• DOI: 10.1097/PEC.0000000000001618
• Languages: English
• ISSNs: 0749-5161

Abstract

Abstract : Objectives: Although closed head injuries occur commonly in children, most do not have a clinically important traumatic brain injury (ciTBI) and do not require neuroimaging. We sought to determine whether the utilization of computed tomography of the head (CT-H) in children presenting to an emergency department (ED) with a closed head injury changed after publication of validated clinical prediction rules to identify children at risk of ciTBI by the Pediatric Emergency Care Applied Research Network (PECARN). Methods: We used the nationwide ED sample (2008–2013) to examine children visiting an ED after a mild closed head injury. Multiple patient and hospital characteristics were assessed. Results: Of the 4, 552, 071 children presenting to an ED with a mild closed head injury, 1, 181, 659 (26.0%) underwent CT-H. Care was most commonly received at metropolitan teaching hospitals (43.5%) and varied markedly by geographic region. Overall, there were no significant changes in the nationwide rates of CT-H utilization in the period immediately after publication of the PECARN prediction rules. However, compared with metropolitan teaching hospitals, CT-H utilization increased significantly for patients treated at nonteaching hospitals and at nonmetropolitan hospitals. Conclusions: There was no overall reduction in CT-H utilization after publication of the 2009 PECARN prediction rules. However, patients treated at metropolitan teaching hospitals were significantly less likely to undergo CT-H after 2009, suggesting some penetration of the PECARN tool in that setting. Further research should study patterns of CT-H utilization in nonteaching hospitals and nonmetropolitan hospitals to assess challenges for adoption of validated pediatric ciTBI prediction rules.