Related Experiment Video
Updated: Oct 2, 2025
Automated Midline Shift and Intracranial Pressure Estimation based on Brain CT Images
Published on: April 13, 2013
Cost-effectiveness of patient observation on cranial CT use with minor head trauma
Sonia Singh1,2,3, Stephen Hearps4, Daniel K Nishijima3
1Department of Paediatrics, The University of Melbourne Faculty of Medicine Dentistry and Health Sciences, Melbourne, Victoria, Australia singhsd@student.unimelb.edu.au.
Insights
Planned observation in emergency departments is a cost-effective strategy for reducing cranial CT scans in children with minor head trauma, particularly for intermediate and high-risk groups.
Area of Science:
- Pediatric Emergency Medicine
- Health Economics
- Radiology
Background:
- Minor head trauma is common in children.
- Cranial CT scans are frequently used but expose children to radiation.
- Identifying cost-effective strategies to reduce unnecessary CT use is crucial.
Purpose of the Study:
- To evaluate the cost-effectiveness of planned observation versus immediate CT scanning in children with minor head trauma.
- To determine the impact on CT utilization and healthcare costs from an Australian public healthcare perspective.
Main Methods:
- Secondary analysis of a multicentre prospective observational study involving 18,471 children.
- Stratification by the Pediatric Emergency Care Applied Research Network (PECARN) traumatic brain injury (TBI) risk categories.
- Net benefit regression analysis using ordinary least squares to estimate cost-effectiveness and CT use reduction.
Main Results:
- Planned observation was cost-saving (€85 reduction) and reduced CT use by 10.4% overall.
- Significant cost savings and CT use reduction were observed in PECARN high-risk (€757, 43% reduction) and intermediate-risk (€52, 11% reduction) categories.
- The very low-risk category showed increased costs with planned observation.
Conclusions:
- Planned emergency department observation is a cost-effective strategy for reducing cranial CT use in children with minor head trauma.
- This approach is particularly beneficial for PECARN intermediate-risk and high-risk pediatric patients.
- Selective use of observation can optimize resource allocation and minimize radiation exposure.
Objective:
To evaluate the cost-effectiveness of planned observation on cranial CT use in children with minor head trauma.
Design:
Planned secondary analysis of a multicentre prospective observation study.
Setting:
Australia and New Zealand.
Patients:
An analytic cohort of 18 471 children aged <18 years with Glasgow Coma Scale scores 14-15 presenting <24 hours after blunt head trauma stratified by the Pediatric Emergency Care Applied Research Network (PECARN) traumatic brain injury (TBI) risk categories.
Intervention:
A plan for observation and immediate CT scan were documented after the initial assessment. The planned observation group included those with planned observation and no immediate plan for CT.
Main Outcome Measures:
Taking an Australian public-funded healthcare perspective, we estimated the cost-effectiveness of planned observation on the adjusted mean costs per child and CT use reduction by net benefit regression analysis using ordinary least squares with robust SEs and bootstrapping. All costs presented in 2018 euros.
Results:
Planned observation in 4945 (27%) children was cost-saving of €85 (95% CI -120 to -51) with 10.4% lower CT use (95% CI 9.6 to 11.2). This strategy was cost-saving for the PECARN high-risk (-€757 (95% CI -961 to -554)) and intermediate-risk (-€52 (95% CI -99 to -4.3)) categories, with 43% (95% CI 39 to 47) and 11% (95% CI 9.6 to 12.4) lower CT use, respectively. The very low-risk category incurred more cost of €86 (95% CI 67 to 104) with planned observation and 0.05% lower CT use (95% CI -0.61 to 0.71).
Conclusion:
Planned ED observation in selected children with minor head trauma is cost-effective for reducing CT use for the PECARN intermediate-risk and high-risk categories.
Trial Registration Number:
ACTRN12614000463673.
