Related Experiment Video
Updated: May 13, 2026
A Multi-Modal Approach to Assessing Recovery in Youth Athletes Following Concussion
Published on: September 25, 2014
Variation in specialists' reported hospitalization practices of children sustaining blunt head trauma
Cheryl W Vance1, Moon O Lee, James F Holmes
1University of California Davis, Department of Pediatrics, Davis, California ; University of California Davis, Department of Emergency Medicine, Davis, California.
Insights
Physician preferences vary for discharging children with blunt head trauma (BHT) and CT findings. Specialists differ on hospitalizing patients even with minor skull fractures, impacting pediatric emergency care.
Area of Science:
- Pediatric Emergency Medicine
- Neurosurgery
- Trauma Surgery
Background:
- Determining appropriate emergency department (ED) disposition for children with blunt head trauma (BHT) remains a challenge.
- Physician preferences for managing pediatric BHT cases with varying computed tomography (CT) findings require identification.
Purpose of the Study:
- To identify disposition preferences of pediatric and general emergency physicians, neurosurgeons, and trauma surgeons for children with BHT and specific CT findings.
- To evaluate predictors of patient discharge based on specialty, hospital, and clinician experience.
Main Methods:
- Survey of pediatric and general emergency physicians, pediatric and general neurosurgeons, pediatric surgeons, and trauma surgeons.
- Presentation of two hypothetical pediatric BHT cases with varying CT findings to assess disposition preferences.
- Multivariable regression analysis to identify predictors of discharge, adjusting for relevant factors.
Main Results:
- Most physicians would discharge children with linear skull fractures (71% for a 9-year-old, 62% for an 11-month-old).
- Neurosurgeons were more likely to discharge patients with small subarachnoid hemorrhages compared to emergency physicians.
- Pediatric surgeons were least likely to discharge patients with any CT finding, including linear skull fractures.
Conclusions:
- Significant inter-specialty variation exists in the reported hospitalization practices for neurologically normal children with BHT and traumatic CT findings.
- These variations highlight the need for standardized guidelines in managing pediatric head trauma cases.
Introduction:
Questions surround the appropriate emergency department (ED) disposition of children who have sustained blunt head trauma (BHT). Our objective was to identify physician disposition preferences of children with blunt head trauma (BHT) and varying computed tomography (CT) findings.
Methods:
WE SURVEYED PEDIATRIC AND GENERAL EMERGENCY PHYSICIANS (EP), PEDIATRIC NEUROSURGEONS (PNSURG), GENERAL NEUROSURGEONS (GNSURG), PEDIATRIC SURGEONS (PSURG) AND TRAUMA SURGEONS REGARDING CARE OF TWO HYPOTHETICAL PATIENTS: Case 1: a 9-year-old who fell 10 feet and Case 2: an 11-month-old who fell 5 feet. We presented various CT findings and asked physicians about disposition preferences. We evaluated predictors of patient discharge using multivariable regression analysis adjusting for hospital and ED characteristics and clinician experience. Pediatric EPs served as the reference group.
Results:
Of 2,341 eligible surveyed, 715 (31%) responded. Most would discharge children with linear skull fractures (Case 1, 71%; Case 2, 62%). Neurosurgeons were more likely to discharge children with small subarachnoid hemorrhages (Case 1 PNSurg OR 6.87, 95% CI 3.60, 13.10; GNSurg OR 6.54, 95% CI 2.38, 17.98; Case 2 PNSurg OR 5.38, 95% CI 2.64, 10.99; GNSurg OR 6.07, 95% CI 2.08, 17.76). PSurg were least likely to discharge children with any CT finding, even linear skull fractures (Case 1 OR 0.14, 95% CI 0.08, 0.23; Case 2 OR 0.18, 95% CI 0.11, 0.30). Few respondents (<6%) would discharge children with small intraventricular, subdural, or epidural bleeds.
Conclusion:
Substantial variation exists between specialties in reported hospitalization practices of neurologically-normal children with BHT and traumatic CT findings.
More Related Videos
09:49Assessing Changes in Synaptic Plasticity Using an Awake Closed-Head Injury Model of Mild Traumatic Brain Injury
Published on: January 20, 2023
07:02An Investigation of the Effects of Sports-related Concussion in Youth Using Functional Magnetic Resonance Imaging and the Head Impact Telemetry System
Published on: January 12, 2011
Related Concept Videos
01:28Traumatic Brain Injury l: Introduction
01:21Types of Reports II: Incident or Occurrence Report
Purposes:
In the healthcare industry, reports play a crucial role in documenting incidents within an agency. The primary objective of these reports is to ensure patient safety, uphold the...