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Influence of guidelines on management of paediatric mild traumatic brain injury: CT-assessment and admission policy
J J Lenstra1, A R A Pikstra1, J M Fock2
1Department of Neurology, University of Groningen, University Medical Center Groningen, The Netherlands.
Insights
A Dutch guideline for pediatric mild traumatic brain injury (mTBI) increased computed tomography (CT) scans and hospital admissions. Guideline adherence was 57%, but CT use varied by age and risk factors.
Area of Science:
- Pediatric Emergency Medicine
- Radiology
- Clinical Guideline Implementation
Background:
- Rising rates of pediatric injury-related emergency visits and computed tomography (CT) use pose cancer risks.
- A 2010 Dutch guideline aimed to standardize CT assessment for mild traumatic brain injury (mTBI) in pediatric emergency departments.
Purpose of the Study:
- To evaluate the impact of a pediatric mild traumatic brain injury (mTBI) guideline on CT scan frequency and hospital admissions.
- To assess factors influencing adherence to the CT assessment guideline.
Main Methods:
- Retrospective cohort study of pediatric patients (<18 years) with mTBI (Glasgow Coma Scale 13-15).
- Comparison of data from before (2008-2010) and after (2011-2014) guideline implementation at a university medical center.
- Primary outcomes: CT scan frequency and hospital admission rates.
Main Results:
- CT scans increased from 32% to 46% (p=0.001), particularly in children aged 6-18 years.
- Hospital admissions rose from 38% to 54% (p<0.001), notably in children under 6 years.
- Guideline adherence was 57%, with CT use varying by age and specific risk factors; no significant increase in CT-abnormality detection.
Conclusions:
- The implemented pediatric mTBI guideline led to increased CT utilization and hospital admissions.
- Despite improved adherence, cranial CT scan application in clinical practice varies across age groups and depends on risk factor assessment.
Background:
The annual number of paediatric injury-related emergency visits and application of computed tomography (CT) has substantially increased, with associated higher risk of malignancies. In 2010, a guideline for CT-assessment based on risk factors for patients with mild traumatic brain injury (mTBI) became effective in all Emergency Departments (ED) in the Netherlands. This study evaluated the influence of this guideline on the frequency of CT-assessments, hospital admissions and factors that are related to guideline adherence.
Methods:
Retrospective cohort study of paediatric mTBI (<18 years), defined by Glasgow Coma Scale score of 13-15 admitted to the ED of the University Medical Center Groningen from 2008 to 2014. Data before (pre-GL) and after (post-GL) introduction of the guideline were evaluated. Primary outcome parameters were frequency of CT-assessments and hospital admissions after ED.
Results:
In total 633 patients were enrolled and data from pre-GL (n = 216) and post-GL (n = 315) were compared. Mean age was 7.9 years (SD 5.9), 59% were male. CT-assessments increased from 32% to 46% (p = .001), mostly in children aged 6-18 years. Hospital admissions increased from 38% to 54% (p < .001), mostly in children <6 years. No significant increase in CT-abnormalities is seen. Guideline adherence was 57%, although CT-assessments varied from 44 to 100% depending on presence of specific major risk factors.
Conclusions:
Introduction of a new guideline on management of paediatric mTBI showed significant increase in CT-assessments and more hospital admissions. In clinical practice, despite increase of guideline adherence the applications of cranial CT-scan varies within age groups and depends on the weighing of risk factors.
