Computed tomography imaging in children with head trauma: utilization and appropriateness from a quality improvement perspective
M Vera1, G R Fleisher, P D Barnes
1Hospital Epidemiology and Quality Improvement, Children's Hospital, Boston, MA 02115.
Insights
Computed tomography (CT) scans are crucial for evaluating pediatric head trauma. A study found 95% of children receiving CT scans met established criteria, indicating appropriate utilization for head injury assessment.
Area of Science:
- Pediatric Radiology
- Emergency Medicine
- Quality Improvement
Background:
- Computed tomography (CT) is vital for acute pediatric head trauma evaluation.
- Disagreements arose regarding CT utilization and appropriateness in pediatric head trauma cases.
- Lack of formal institutional criteria prompted the development of new guidelines.
Purpose of the Study:
- To address interdepartmental disagreements on CT utilization for pediatric head trauma.
- To develop and implement evidence-based institutional criteria for CT scans in pediatric head trauma.
- To assess the appropriateness of CT scan utilization in this patient population.
Main Methods:
- An interdepartmental quality improvement team was formed.
- Literature review informed the development of consensus-based institutional criteria.
- A retrospective review of CT utilization over one year was conducted.
Main Results:
- The majority (95%) of pediatric head trauma patients receiving CT scans met the newly established criteria.
- Little correlation was found between the presence of criteria and abnormal CT findings.
- CT results significantly influenced decisions regarding patient admission or discharge.
Conclusions:
- Established criteria support the appropriate utilization of CT scans in pediatric head trauma.
- CT scan results impact clinical decision-making for pediatric head trauma patients.
- Patients discharged with normal CT scans or no CT scans demonstrated uniformly good outcomes.
Abstract:
Computed tomography (CT) imaging plays an important role in the acute evaluation and management of children with head trauma. When routine quality improvement (QI) meetings with representatives from the Children's Hospital radiology and emergency departments revealed disagreement regarding the utilization and appropriateness of CT in children presenting with head trauma, an interdepartmental QI team was formed to address this issue. Because formal criteria for obtaining CTs for head trauma were unavailable, internal institutional criteria were developed by consensus after literature review. Contrary to perceptions of some staff members, the majority (95%) of children who received CT met at least one of the established criteria over a one-year study period. There was little relationship between the presence of criteria and abnormal CT results, but decisions whether to admit patients to the hospital or to send them home were influenced by CT results. Follow-up studies suggested that patients who were discharged home with a normal CT or no CT had uniformly good outcomes.
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