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CT for pediatric, acute, minor head trauma: clinician conformity to published guidelines
L L Linscott1, M M Kessler, D R Kitchin
1Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO 63110, USA. luke.linscott@gmail.com
Insights
A 2001 estimate suggested 30% of pediatric head CT scans were unnecessary. This study found that clinician adherence to guidelines for head CT in children with minor head trauma is significantly higher than previously suggested.
Area of Science:
- Pediatric Radiology
- Medical Imaging
- Evidence-Based Medicine
Background:
- An informal 2001 poll suggested 30% of pediatric head CTs were unnecessary.
- Concerns about radiation exposure and costs necessitate objective evaluation of head CT utilization in children.
Purpose of the Study:
- To test the hypothesis that 30% of head CT examinations for acute, minor head trauma in children are performed unnecessarily.
- To assess clinician adherence to established clinical guidelines for pediatric head CT.
Main Methods:
- Retrospective review of 182 pediatric patients with acute, minor head trauma.
- Evaluation of clinician adherence to published guidelines for children aged <2 years and 2-20 years.
- Binomial test used to compare actual unnecessary CT rates against the 30% hypothesis.
Main Results:
- Only 2.6% of head CTs in children <2 years and 11.5% in children 2-20 years did not conform to guidelines.
- These rates were significantly lower than the hypothesized 30% (P < .001).
Conclusions:
- Clinician adherence to head CT guidelines for minor head trauma in children is substantially better than previously estimated.
- The findings challenge the 2001 informal poll's assertion regarding unnecessary pediatric head CT examinations.
Background And Purpose:
In 2001, pediatric radiologists participating in a panel discussion on CT dose reduction suggested that approximately 30% of head CT examinations were performed unnecessarily. With increasing concern regarding radiation exposure to children and imaging costs, this claim warrants objective study. The purpose of this study was to test the null hypothesis that 30% of head CT studies for clinical evaluation of children with acute, minor head trauma do not follow established clinical guidelines.
Materials And Methods:
Retrospective review of 182 consecutive patients with acute, minor head trauma from February 2009 to January 2010 at a tertiary care children's hospital emergency department was performed, and clinician adherence to published clinical guidelines for children younger than 2 years and children 2-20 years of age was determined. The binomial test was used for a null hypothesis of 30% unnecessary examinations against the actual percentage of head CTs deemed unnecessary on the basis of established guidelines. Statistical testing was performed for children younger than 2 years and 2-20 years of age.
Results:
For children younger than 2 years of age, 2 of 78 (2.6%; 95% CI, 0.5%-8.3%) and, for children 2-20 years of age, 12 of 104 (11.5%; CI, 6.4%-18.7%) did not conform to established guidelines. These percentages were significantly less than the hypothesized value of 30% (P < .001).
Conclusions:
Clinician conformity to published guidelines for use of head CT in acute, minor head trauma is better than suggested by a 2001 informal poll of pediatric radiologists.
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