Emergency Department Practice Variation in Computed Tomography Use for Children with Minor Blunt Head Trauma - 21/11/14
, John D. Hoyle, MD 2, Peter S. Dayan, MD, MSc 3, Shireen Atabaki, MD, MPH 4, Lois Lee, MD, MPH 5, Kathy Lillis, MD 6, Marc H. Gorelick, MD, MSCE 7, Richard Holubkov, PhD 8, Michelle Miskin, MS 8, James F. Holmes, MD, MPH 9, J. Michael Dean, MD, MBA 8, Nathan Kuppermann, MD, MPH 9and the
Pediatric Emergency Care Applied Research Network (PECARN)∗
Abstract |
Objective |
To describe factors associated with computed tomography (CT) use for children with minor blunt head trauma that are evaluated in emergency departments.
Study design |
Planned secondary analysis of a prospective observational study of children <18 years with minor blunt head trauma between 2004 and 2006 at 25 emergency departments. CT scans were obtained at the discretion of treating clinicians. We risk-adjusted patients for clinically important traumatic brain injuries and performed multivariable regression analyses. Outcome measures were rates of CT use by hospital and by clinician training type.
Results |
CT rates varied between 19.2% and 69.2% across hospitals. Risk adjustment had little effect on the differential rate of CT use. In low- and middle-risk patients, clinicians obtained CTs more frequently at suburban and nonfreestanding children's hospitals. Physicians with emergency medicine (EM) residency training obtained CTs at greater rates than physicians with pediatric residency or pediatric EM training. In multivariable analyses, compared with pediatric EM–trained physicians, the OR for CT use among EM-trained physicians in children <2 years was 1.24 (95% CI 1.04-1.46), and for children >2 years was 1.68 (95% CI 1.50-1.89). Physicians of all training backgrounds, however, overused CT scans in low-risk children.
Conclusions |
Substantial variation exists in the use of CT for children with minor blunt head trauma not explained by patient severity or rates of positive CT scans or clinically important traumatic brain injuries.
Le texte complet de cet article est disponible en PDF.Keyword : ciTBI, CT, ED, EM, GCS, PECARN, PEM, TBI
Plan
| Supported in part by the Health Resources and Services Administration (HRSA), Maternal and Child Health Bureau (MCHB; R40MC02461), the Emergency Medical Services of Children (EMSC) Program through the PECARN. PECARN is supported by the following cooperative agreements: U03MC00001, U03MC00003, U03MC00006, U03MC00007, U03MC00008, U03MC22684, and U03MC22685. The authors declare no conflicts of interest. |
Vol 165 - N° 6
P. 1201 - décembre 2014 Retour au numéro
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