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Emergency department practice variation in computed tomography use for children with minor blunt head trauma
Rachel M Stanley1, John D Hoyle2, Peter S Dayan3
1Department of Emergency Medicine and Pediatrics, University of Michigan, Ann Arbor, MI.
Insights
Computed tomography (CT) use varies widely for children with minor head trauma. Physician training and hospital type influence CT scans, even in low-risk cases.
Area of Science:
- Pediatric Emergency Medicine
- Radiology
- Health Services Research
Background:
- Computed tomography (CT) is frequently used for evaluating children with minor blunt head trauma in emergency departments.
- Factors influencing CT utilization in this population are not fully understood, leading to potential overuse and associated risks.
Purpose of the Study:
- To identify factors associated with computed tomography (CT) use in children under 18 years old presenting with minor blunt head trauma to emergency departments.
- To examine variations in CT utilization based on hospital characteristics and clinician training.
Main Methods:
- Secondary analysis of a prospective observational study involving 25 emergency departments from 2004 to 2006.
- Risk-adjusted multivariable regression analyses were performed to assess the association between patient severity, hospital type, clinician training, and CT use.
- Outcome measures included rates of CT use stratified by hospital and clinician training background.
Main Results:
- CT utilization rates varied significantly across hospitals, ranging from 19.2% to 69.2%.
- Physicians with emergency medicine (EM) residency training utilized CT scans more frequently than those with pediatric residency or pediatric EM training, particularly in children over 2 years.
- CT scans were more commonly used in low- and middle-risk patients at suburban and non-freestanding children's hospitals, and overuse was noted across all training backgrounds in low-risk children.
Conclusions:
- Significant unexplained variation exists in CT use for pediatric minor blunt head trauma.
- Patient severity and rates of clinically important traumatic brain injuries do not fully account for the observed differences in CT utilization.
- Further research is needed to optimize CT decision-making in this patient group to reduce unnecessary radiation exposure.
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.
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