CT Use for Pediatric Mild Brain Injuries by Hospital Type: 2017 to 2023

Our objective was to descriptively examine national patterns of head computed tomography (CT) use for pediatric patients with mild traumatic brain injury (mTBI) across adult, pediatric, and mixed hospitals.

We conducted a retrospective study of children aged older than 18 years with isolated mTBI treated at National Trauma Data Bank-participating hospitals from 2017 to 2023. Hospitals were categorized as adult, pediatric, or mixed based on American College of Surgeons verification levels and state-level designations. We computed annual CT scan rates and 95% bootstrap CI overall and stratified by patient demographics, clinical features, and hospital characteristics. Subgroup analyses described CT use among scanned patients.

Among 12 030 children with isolated mTBI during the study period, 32.1% were treated at adult hospitals, 31.6% at pediatric hospitals, and 36.2% at mixed hospitals. Overall, head CT use remained high with minimal variation over the study period, ranging from 43.5% to 51.5%. Adult hospitals consistently demonstrated the highest CT use (59.5%), followed by mixed hospitals (44.0%) and pediatric hospitals (38.8%). Increased imaging rates were observed among patients with lower Glasgow coma scale scores, impaired consciousness, and those treated in nonteaching or smaller hospitals. Most scanned patients were male, white, privately insured, and treated at level I or II trauma centers.

Despite national guidelines, head CT use in pediatric mTBI remains high across all hospital types. These findings reveal persistent gaps in guidelines adoption and call for targeted interventions to reduce unnecessary imaging. Future research should identify barriers to adherence and institutional factors driving variability.