Computed Tomography Utilization in the Management of Children with Mild Head Trauma

Area of Science:

• Pediatric Emergency Medicine
• Radiology
• Health Services Research

Background:

• Mild traumatic brain injury (mTBI) in children often leads to unnecessary computed tomography (CT) scans.
• The Pediatric Emergency Care Applied Research Network (PECARN) provides evidence-based guidelines to reduce CT use in pediatric mTBI.
• The Safe CT Imaging Collaborative Initiative aimed to implement PECARN rules in New Jersey hospitals.

Purpose of the Study:

• To evaluate the trend of CT usage for pediatric mTBI before and after the Safe CT Imaging Collaborative Initiative.
• To compare CT utilization rates between children's hospitals and general hospitals.
• To assess the impact of the initiative on adherence to PECARN guidelines.

Main Methods:

• Retrospective analysis of administrative databases from 10 children's and 59 general hospitals in New Jersey.
• Comparison of CT usage rates during three periods: baseline (2014-2015), program initiation (2016), and post-implementation (2017-2019).
• Time-series modeling and regression analysis to identify trends and predictors of CT reduction.

Main Results:

• CT usage rates were consistently lower in children's hospitals (19.2% to 14.2%) compared to general hospitals (36.7% to 21.0%).
• The initiative demonstrated a significant trend of CT reduction in pediatric mTBI patients within four years, with the most substantial decrease during the first year.
• Higher baseline CT usage rates predicted greater CT reduction, independent of hospital type or patient volume.

Conclusions:

• The Safe CT Imaging Collaborative Initiative was effective in reducing CT utilization for pediatric mTBI in New Jersey hospitals.
• Implementation of evidence-based guidelines can significantly decrease unnecessary imaging in pediatric emergency care.
• Hospital type and baseline CT usage are key factors influencing the success of imaging reduction initiatives.