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Reduction of paediatric head CT utilisation at a rural general hospital emergency department
Jeffrey Paul Louie1, Joseph Alfano2, Thuy Nguyen-Tran3
1Pediatrics, University of Minnesota, Minneapolis, Minnesota, USA louie003@umn.edu.
Insights
Quality improvement interventions successfully reduced head computed tomography (CT) rates in children with blunt head injury at a rural emergency department. This initiative decreased unnecessary radiation exposure for pediatric patients.
Area of Science:
- Pediatric Emergency Medicine
- Radiology
- Quality Improvement Science
Background:
- Blunt head injury is a frequent pediatric emergency, often leading to head computed tomography (CT) scans.
- Approximately 50% of children with head injuries undergo head CT, potentially involving unnecessary radiation exposure.
- Quality improvement (QI) initiatives in academic centers have proven effective in reducing head CT rates.
Purpose of the Study:
- To decrease head computed tomography (CT) utilization in a rural community emergency department for pediatric blunt head injury cases.
- To implement and assess the impact of QI measures in a non-academic, rural setting.
Main Methods:
- A series of interventions were developed and implemented in a rural emergency department over a study period.
- Data on head CT rates for children with blunt head injury were collected before and after the interventions.
- Pre- and post-intervention data were analyzed using control charts to assess changes in head CT rates.
Main Results:
- The study included 576 children, with 237 in the pre-intervention group and 339 in the post-intervention group.
- The head CT rate decreased from 41.8% pre-intervention to 27.7% post-intervention, a significant reduction of 14.1%.
- Interventions demonstrated an incremental decrease in head CT rates, showing a statistically significant improvement.
Conclusions:
- A series of QI interventions effectively reduced head computed tomography (CT) utilization in pediatric blunt head injury cases.
- The methodology proved successful in a rural community emergency department setting.
- The study highlights the feasibility of implementing QI measures to reduce unnecessary imaging in diverse healthcare environments.
Background:
Blunt head injury is a common pediatric injury and often evaluated in general emergency departments. It estimated that 50% of children will undergo a head computed tomography (CT), often unnecessarily exposing the child to ionizing radiation. Pediatric academic centers have shown quality improvement (QI) measures can reduce head CT rates within their emergency departments. We aimed to reduce head CT utilization at a rural community emergency department.
Methods:
Children presenting with a complaint of blunt head injury and were evaluated with or without a head CT. Head CT rate was the primary outcome. We developed a series of interventions and presented these to the general emergency department over the duration of the study. The pre and intervention data was analysed with control charts.
Results:
The preintervention and intervention groups consisted of 576 children: 237 patients with a median age of 8.0 years and 339 patients with a median age of 9.00 years (p=0.54), respectively. The preintervention HCT rate was 41.8% (95% CI 35.6% to 48.1%) and the postintervention rate was 27.7% (95% CI 23.3% to 32.7%), a decrease of 14.1% (95% CI 6.2% to 21.9%, p=0.0004). During the intervention period, there was a decrease in HCT rate of one per month (OR 0.96, 95% CI 0.92 to 1.00, p=0.07). The initial series of interventions demonstrated an incremental decrease in HCT rates corresponding with a special cause variation.
Conclusion:
The series of interventions dispersed over the intervention period was an effective methodology and successfully reduced HCT utilisation among children with blunt head injury at a rural community emergency department.
