Pediatricians as Case Managers Reduce the Exposure to Computerized Tomography in Children Experiencing Minor Head
Yuri Fishman1, Itai Gross2, Saar Hashavya2
1From the Department of General Surgery, Hadassah and Hebrew University Hospital.
Insights
Pediatricians/pediatric emergency medicine physicians (PEMP) reduce head computerized tomography (CT) scan rates in children with mild head trauma, lowering radiation exposure without compromising injury detection. This suggests PEMPs should manage these cases when possible.
Area of Science:
- Pediatric Emergency Medicine
- Radiology
- Neurotrauma
Background:
- Head trauma is a frequent cause of pediatric emergency department visits.
- Computerized tomography (CT) scans diagnose traumatic brain injury but increase malignancy risk.
Purpose of the Study:
- To compare CT scan rates and outcomes in children with mild head trauma treated by pediatricians/pediatric emergency medicine physicians (PEMP) versus surgeons.
- To evaluate the impact of physician specialty on radiation exposure and diagnostic accuracy.
Main Methods:
- Retrospective analysis of 4232 children (0-16 years) with mild head trauma from 2010-2015.
- Comparison of CT utilization and findings between patients managed by PEMPs and surgeons.
Main Results:
- Pediatricians ordered significantly fewer CT scans (5.4% vs. 8.5%) than surgeons.
- Children managed by pediatricians had 4.3 times lower odds of undergoing a CT scan.
- CT scan rates were reduced by PEMP management without increased readmissions or complications.
Conclusions:
- PEMP management of mild head trauma in children decreases CT scan rates and radiation exposure.
- This approach effectively identifies clinically important traumatic brain injuries.
- Prioritizing PEMP care for these pediatric patients is recommended.
Background:
Head trauma is one of the most common reasons for pediatric emergency medicine department (PED) visits. Computerized tomography (CT) scan is considered the criterion standard for the diagnosis of traumatic brain injury but was shown to increases the risk of malignancies.
Methods:
We retrospectively analyzed collected data of all children (ages 0-16 years) experiencing mild head trauma who were admitted to a single center, from January 1, 2010, to December 31, 2015. Comparison between patients treated by pediatricians/pediatric emergency medicine physicians (PEMP) with those treated by surgeons regarding CT rates and prognosis was done.
Results:
During the previously mentioned period, 4232 children presented to the PED after minor head trauma, the average age was 5.4 (±4) years and 67.1% were male. Head CT was done in 7.7%, of which 30.7% had positive findings. Younger children tended to have higher percentage of positive findings on CT scan (60%, 43.8%, 26.6%, P = 0.003, for children up to 5 months, 5-24 months, and older than 24 months, respectively). Pediatricians ordered less CT scans when compared with surgeons (5.4% vs 8.5%, P < 0.001). Moreover, they had higher rates of positive findings on CT scan (52.5% vs 25.8%, P < 0.001). When all other characteristics were similar, if the case manager was a pediatrician, the patient's chances to undergo a CT scan were 4.3 times lower than if the case manager was a surgeon (odds ratio, 4.277; confidence interval, 2.274-7.104). No difference in readmissions or other complications were found between the 2 groups.
Discussion:
This study highlights that when the case manager of children with minor head trauma is a pediatrician/PEMP, CT scan rates and thus exposure to radiation are diminished without a failure to detect clinically important traumatic brain injury.In conclusion, our findings suggest that when possible, all children experiencing minor head trauma should be treated by a pediatrician/PEMP in the PED.
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