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Trauma center variation of head computed tomography utilization in children presenting with mild traumatic brain
Noam Gerber1, Swapna Munnangi1, Yasaswi Vengalasetti2
1Department of Surgery, Nassau University Medical Center, East Meadow, NY, United States of America.
Insights
Pediatric trauma centers are less likely to perform head CT scans on children with mild traumatic brain injury (mTBI) and loss of consciousness compared to adult trauma centers. This finding highlights variations in head CT utilization for pediatric mTBI care.
Area of Science:
- Emergency Medicine
- Pediatric Trauma Surgery
- Radiology
Background:
- Clinical decision rules exist for head CT in pediatric mild traumatic brain injury (mTBI).
- However, current practices for head CT utilization in pediatric mTBI vary significantly.
- This variability may stem from differences in trauma center designations.
Purpose of the Study:
- To compare head CT utilization in pediatric mTBI patients between American College of Surgeons-verified Pediatric Trauma Centers (ACS-PTC) and Adult-Only Trauma Centers (ACS-AOTC).
- To identify potential disparities in diagnostic imaging based on trauma center type.
Main Methods:
- Retrospective cohort study of 24,104 pediatric patients (≤17 years) with isolated mTBI.
- Data from 337 ACS-verified level I/II trauma centers (2011-2015) via National Trauma Data Bank.
- Multivariable logistic regression analyzed head CT odds, controlling for confounders and assessing effect modification by loss of consciousness (LOC).
Main Results:
- Overall adjusted odds of receiving a head CT did not differ significantly between ACS-PTCs and ACS-AOTCs (OR: 0.98).
- However, pediatric patients with a loss of consciousness (LOC) were significantly less likely to receive a head CT at an ACS-PTC compared to an ACS-AOTC (OR: 0.71).
Conclusions:
- Children with mTBI and LOC presenting to ACS-verified trauma centers are less likely to undergo head CT at pediatric trauma centers than at adult-only trauma centers.
- This suggests a potential underutilization of head CT in a vulnerable pediatric subpopulation at specialized pediatric centers.
Background:
Although published clinical decision rules have identified indications for the use of head CT in children with mild traumatic brain injury, practices vary.
Objective:
This study seeks to evaluate whether the utilization of head CT in pediatric trauma patients presenting with mTBI varies between American College of Surgeons verified pediatric trauma centers (ACS-PTC) and adult-only trauma centers (ACS-AOTC).
Material And Methods:
A retrospective cohort study of 24,104 trauma patients, ≤17, who presented to the emergency department at 337 ACS verified level I/II trauma centers with isolated mTBI was conducted using National Trauma Data Bank records (2011-2015). Multivariable logistic regression was used to compare the odds of a patient receiving a head CT when treated at an ACS-PTC vs. an ACS-AOTC, controlling for demographic, injury, and hospital-level confounders. Effect modification by loss of consciousness was assessed and adjusted head CT odds were recalculated in patients stratified by LOC status.
Results:
There was no significant difference in the adjusted odds of receiving a head CT at an ACS-PTC vs. an ACS-AOTC (odds ratio: 0.98, 95% confidence interval: 0.92-1.04). However, in patients who had a LOC, the adjusted OR of receiving a head CT at an ACS-PTC vs ACS-AOTC was 0.71 (95% confidence interval: 0.65-0.78).
Conclusion:
Children presenting to the emergency department of an ACS-verified level I or II trauma center with mTBI who had a loss of consciousness are less likely to receive a head CT at an ACS verified pediatric trauma center than at an ACS verified adult-only trauma center.
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