Selecting children for head CT following head injury
A Kemp1, E Nickerson1, L Trefan1
1College of Biomedical and Life Sciences, School of Medicine, Cardiff University, Cardiff, Wales, UK.
Insights
National Institute for Health and Care Excellence (NICE) guidelines for head CT scans in children show variable compliance and diagnostic yield. This practice risks both missing injuries and unnecessary CT scans.
Area of Science:
- Pediatric emergency medicine
- Radiology
- Health services research
Background:
- The National Institute for Health and Care Excellence (NICE) developed guidelines in 2007 to standardize head CT scan indications in children with head injuries.
- Variations in clinical practice may lead to suboptimal CT scan utilization, potentially missing intracranial injuries or performing unnecessary scans.
Purpose of the Study:
- To analyze head CT scan uptake, identify factors influencing its use, and determine the diagnostic yield in children following head injury, based on NICE guidelines.
- To assess compliance with NICE guidelines for head CT scans in pediatric head injury cases.
Main Methods:
- A cross-sectional study analyzing data from hospital inpatient units in England, Wales, Northern Ireland, and the Channel Islands.
- Inclusion criteria: Children (<15 years) admitted for >4 hours after head injury between September 2009 and February 2010.
- Outcome measures: CT scan rates, adherence to NICE guidelines, and diagnostic yield.
Main Results:
- CT scans were performed on 30.4% of 5700 analyzed children. Diagnostic yield was higher in infants (56.5%) than older children (26.5%).
- Only 40.4% of children meeting NICE criteria for CT actually received one. CT use was lower in general hospitals compared to specialist centers (OR 0.52).
- Children over 3 years were more likely to receive a CT scan when indicated (OR 2.35) compared to younger children. Significant regional variations in CT use were observed.
Conclusions:
- Compliance with NICE guidelines for head CT scans in pediatric head injury is variable across age groups, hospital types, and regions.
- The current pattern of clinical practice presents considerable risks of both underutilization (missing injuries) and overutilization (unnecessary scans).
- Further research and implementation strategies are needed to improve adherence to guidelines and optimize CT scan use in pediatric head trauma.
Objective:
Indicators for head CT scan defined by the 2007 National Institute for Health and Care Excellence (NICE) guidelines were analysed to identify CT uptake, influential variables and yield.
Design:
Cross-sectional study.
Setting:
Hospital inpatient units: England, Wales, Northern Ireland and the Channel Islands.
Patients:
Children (<15 years) admitted to hospital for more than 4 h following a head injury (September 2009 to February 2010).
Interventions:
CT scan.
Main Outcome Measures:
Number of children who had CT, extent to which NICE guidelines were followed and diagnostic yield.
Results:
Data on 5700 children were returned by 90% of eligible hospitals, 84% of whom were admitted to a general hospital. CT scans were performed on 30.4% of children (1734), with a higher diagnostic yield in infants (56.5% (144/255)) than children aged 1 to 14 years (26.5% (391/1476)). Overall, only 40.4% (984 of 2437 children) fulfilling at least one of the four NICE criteria for CT actually underwent one. These children were much less likely to receive CT if admitted to a general hospital than to a specialist centre (OR 0.52 (95% CI 0.45 to 0.59)); there was considerable variation between healthcare regions. When indicated, children >3 years were much more likely to have CT than those <3 years (OR 2.35 (95% CI 2.08 to 2.65)).
Conclusion:
Compliance with guidelines and diagnostic yield was variable across age groups, the type of hospital and region where children were admitted. With this pattern of clinical practice the risks of both missing intracranial injury and overuse of CT are considerable.
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