Reducing Computed Tomography Scan Utilization for Pediatric Minor Head Injury in the Emergency Department: A Quality...

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.