Reducing the Cranial CT Rate for Pediatric Minor Head Trauma at Three Community Hospitals

Area of Science:

• Pediatric Emergency Medicine
• Quality Improvement Science
• Radiology Utilization

Background:

• Academic medical centers have historically led efforts to decrease cranial CT (computed tomography) scans in pediatric patients with minor head trauma (MHT).
• Community hospitals manage the majority of pediatric emergency care, necessitating similar quality improvement initiatives in these settings.
• Reducing unnecessary cranial CT scans in MHT is crucial for minimizing radiation exposure and healthcare costs in children.

Purpose of the Study:

• To implement and evaluate a quality improvement initiative aimed at reducing cranial CT utilization in pediatric patients with MHT at three community hospital emergency departments (EDs).
• To assess the safety and effectiveness of the intervention by monitoring rates of clinically important traumatic brain injury.

Main Methods:

• A multidisciplinary team at each site implemented an evidence-based guideline for MHT and provided individual provider feedback on CT rates.
• The intervention was tailored to each hospital's structure, utilizing statistical process control methodology to track CT utilization over time.
• The primary balancing measure monitored was the rate of patients returning to the ED within 72 hours with clinically important traumatic brain injury.

Main Results:

• The study included 3,215 pediatric ED visits for MHT, with 1,962 during the intervention period.
• The cranial CT rate decreased from 18% during the baseline period to 13% during the intervention period, representing a 28% relative reduction.
• No increase in children returning to the ED within 72 hours with clinically important traumatic brain injury was observed.

Conclusions:

• A multicenter quality improvement initiative in community EDs successfully and safely reduced cranial CT scans for pediatric MHT.
• The initiative demonstrated that reducing CT utilization in this population can be achieved without compromising the detection of clinically important traumatic brain injuries.