Related Experiment Video
Updated: Nov 24, 2025
Making MR Imaging Child's Play - Pediatric Neuroimaging Protocol, Guidelines and Procedure
Published on: July 30, 2009
Reducing Computed Tomography Scan Utilization for Pediatric Minor Head Injury in the Emergency Department: A Quality
Rajan Arora1, Emily N White2, Deborah Niedbala3
1From the, Department of Pediatrics, Division of Pediatric Emergency Medicine, Central Michigan University, Children's Hospital of Michigan, Detroit, MI, USA.
Insights
A quality improvement initiative successfully reduced head computed tomography (CT) scan use in children with minor head injuries (MHI). This initiative safely lowered CT utilization without impacting return visits or emergency department length of stay.
Area of Science:
- Pediatric Emergency Medicine
- Radiology Quality Improvement
- Clinical Decision Support
Background:
- Pediatric Emergency Care Applied Research Network (PECARN) prediction rules aim to decrease unnecessary imaging in children with minor head injuries (MHI).
- Computed tomography (CT) scan use remains high in intermediate-risk MHI patients, despite validated guidelines.
- This quality improvement initiative focused on reducing CT utilization in this specific patient group.
Purpose of the Study:
- To decrease computed tomography (CT) scan utilization rates in pediatric patients with intermediate-risk minor head injuries (MHI).
Main Methods:
- A quality improvement project was implemented in a Level I trauma pediatric emergency department.
- Key interventions included provider education, decision support tools, and performance feedback for intermediate-risk MHI patients (ages <18).
- Statistical process control monitored head CT utilization rates, with balancing measures including return visits, ED length of stay, and clinically important traumatic brain injury (ciTBI) on revisit.
Main Results:
- The intervention bundle reduced head CT use from 18.5% to 13.9% in 1,535 eligible patients, an absolute reduction of 4.6% (p=0.015).
- No significant changes were observed in emergency department length of stay or return visit rates.
- Only one revisit with a clinically important traumatic brain injury (ciTBI) occurred during the study period.
Conclusions:
- A multifaceted quality improvement initiative effectively and safely reduced CT utilization in children with intermediate-risk MHI.
- The findings support the implementation of similar strategies to optimize imaging practices in pediatric emergency care.
Background:
The validated Pediatric Emergency Care Applied Research Network (PECARN) prediction rules are meant to aid clinicians in safely reducing unwarranted imaging in children with minor head injuries (MHI). Even so, computed tomography (CT) scan utilization remains high, especially in intermediate-risk (per PECARN) MHI patients. The primary objective of this quality improvement initiative was to reduce CT utilization rates in the intermediate-risk MHI patients.
Methods:
This project was conducted in a Level I trauma pediatric emergency department (ED). Children < 18 years evaluated for intermediate-risk MHI from June 2016 through July 2019 were included. Our key drivers were provider education, decision support, and performance feedback. Our primary outcome was change in head CT utilization rate (%). Balancing measures included return visit within 72 hours of the index visit, ED length of stay (LOS), and clinically important traumatic brain injury (ciTBI) on the revisit. We used statistical process control methodology to assess head CT rates over time.
Results:
A total of 1,535 eligible intermediate-risk MHI patients were analyzed. Our intervention bundle was associated with a decrease in CT use from 18.5% (95% confidence interval [CI] = 14.5% to 22.5%) in the preintervention period to 13.9% (95% CI = 13.8% to 14.1%) in the postintervention period, an absolute reduction of 4.6% (p = 0.015). Over time, no difference was noted in either ED LOS or return visit rate. There was only one revisit with a ciTBI to our institution during the study period.
Conclusions:
Our multifaceted quality improvement initiative was both safe and effective in reducing our CT utilization rates in children with intermediate-risk MHI.
More Related Videos
07:02An Investigation of the Effects of Sports-related Concussion in Youth Using Functional Magnetic Resonance Imaging and the Head Impact Telemetry System
Published on: January 12, 2011
08:30X-ray Dose Reduction through Adaptive Exposure in Fluoroscopic Imaging
Published on: September 11, 2011
Related Concept Videos
01:10Computed Tomography
The technique was invented in the 1970s and is based on the principle that as X-rays pass through the body, they are absorbed or reflected at different levels. In the technique, a patient lies on a motorized platform while a computerized axial tomography (CAT) scanner rotates...
01:27Imaging Studies III: Computed Tomography