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Effect of parental pressure on emergency physicians for computerized tomography imaging request in children with head
Mustafa Boğan1, Mustafa Sabak2, Murat Oktay3
1Emergency Department of Düzce University, Düzce 81620, Turkey.
Insights
Parental pressure for cranial computed tomography (CCT) scans in children with head trauma often leads to unnecessary imaging. These scans, when performed due to parental insistence rather than clinical guidelines, rarely reveal significant injuries and do not result in adverse outcomes.
Area of Science:
- Pediatric Emergency Medicine
- Radiology
- Neurotrauma
Background:
- Head trauma is a common reason for pediatric emergency admissions.
- Cranial computed tomography (CCT) scans are frequently utilized for evaluating head injuries in children.
- Parental concerns can influence medical decision-making regarding diagnostic imaging.
Purpose of the Study:
- To evaluate the findings of CCT scans performed due to parental pressure in pediatric head trauma cases.
- To compare the outcomes of CCT scans obtained through parental insistence versus those indicated by clinical guidelines (PECARN).
Main Methods:
- Retrospective analysis of 227 pediatric patients with head trauma.
- Categorization of patients into PECARN guideline group and parental pressure group.
- Review of CCT scan findings and clinical outcomes including surgical intervention and mortality.
Main Results:
- 158 patients underwent CCT scans, with 24 (10.6%) showing pathological findings (most common: linear fracture).
- The parental pressure group (n=33) represented 22.2% of CCT scans performed.
- No cases in the parental pressure group showed clinically significant traumatic brain injury (ciTBI), surgical operation, or mortality.
Conclusions:
- A significant proportion of children with head trauma undergo CCT scans due to parental pressure, even when not indicated by PECARN guidelines.
- CCT scans prompted by parental insistence in head trauma cases are unlikely to reveal serious injuries or lead to adverse outcomes.
- Adherence to established clinical guidelines like PECARN is crucial to avoid unnecessary radiation exposure and healthcare costs associated with non-indicated CCT scans.
Background:
Both minor and major head traumas constitute an important proportion of childhood emergency admissions. In this study, the findings of cranial computed tomography (CCT) scans performed as a result of the parental pressure were evaluated.
Methods:
The frequency and findings of CCT scans performed as a result of parental pressure were examined in a separate subgroup.
Results:
A total of 227 patients were included in the study; 158 (69.9%) patients had undergone CCT scans; a pathological finding was detected in 24 (10.6%) of these patients and undergone a consultation by the neurosurgeon (most common finding was isolated linear fracture; n = 12; 50%). The patients undergoing CCT scans were divided in two subgroups: the PECARN group [n = 123 (77.8%)] and the Parental pressure group [n = 33 (22.2%)].
Conclusion:
One third of the parents of children who presented to the emergency department with head trauma and had no indication for CCT according to PECARN rules insisted on CCT imaging, and none of these cases showed ciTBI, surgical operation, or mortality. None of the patients in the parental pressure group had a history of surgical intervention or mortality within one month after discharge.
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