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Emerg Med Australas. 2019 Nov 26. doi: 10.1111/1742-6723.13396. [Epub ahead of print]

Imaging and admission practices in paediatric head injury across emergency departments in Australia and New Zealand: A PREDICT study.

Author information

1
Emergency Department, Queensland Children's Hospital, Brisbane, Queensland, Australia.
2
Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia.
3
Emergency Department, Starship Children's Health, Auckland, New Zealand.
4
Liggins Institute, The University of Auckland, Auckland, New Zealand.
5
Emergency Department, Perth Children's Hospital, Perth, Western Australia, Australia.
6
Divisions of Paediatrics and Emergency Medicine, School of Medicine, The University of Western Australia, Perth, Western Australia, Australia.
7
Emergency Department, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.
8
Emergency Research Unit, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.
9
Emergency Department, Bristol Royal Hospital for Children, Bristol, UK.
10
Academic Department of Emergency Care, University of the West of England, Bristol, UK.
11
Department of Women's and Children's Health, University of Padova, Padova, Italy.
12
Emergency Department, The Royal Children's Hospital, Melbourne, Victoria, Australia.
13
Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia.
14
Emergency Department, Women's and Children's Hospital, Adelaide, South Australia, Australia.
15
Emergency Department, The Townsville Hospital, Townsville, Queensland, Australia.
16
Emergency Department, Kidz First Children's Hospital, Auckland, New Zealand.

Abstract

OBJECTIVES:

Variation in the management of paediatric head injury has been identified worldwide. This prospective study describes imaging and admission practices of children presenting with head injury across 10 hospital EDs in Australia and New Zealand.

METHODS:

Prospective observational multicentre study of 20 137 children (under 18 years) as a planned secondary analysis of the Australasian Paediatric Head Injury Rules Study. All presentations with head injury without prior imaging were eligible for inclusion. Variations in rates of computed tomography of the brain (CTB) and admission practices between sites, ED type and country were investigated, as were clinically important traumatic brain injuries (ciTBIs) and abnormal CTBs within CTBs.

RESULTS:

Among the 20 137 enrolled patients, the site adjusted CTB rate was 11.2% (95% confidence interval [CI] 7.8-14.6); individual sites ranged from 2.6 to 18.6%. ciTBI was found in 0.4-2.2%, with abnormal scans documented in 0.7-6.5%. As a percentage of CTBs undertaken, ciTBIs were found in 12.8% (95% CI 10.8-14.7) with individual site variation of 8.8-16.9%, and no statistically significant difference noted, and traumatic abnormalities in 29.3% (95% CI 26.2-32.3) with individual site variation between 19.4 and 35.6%. Among those under 2 years,traumatic abnormalities were found in greater than 50% of CTBs at 90% of sites. Admission rate overall was 24.0% (site adjusted) with wide variation between sites (5.0-48.9%).

CONCLUSION:

Across the 10 largely tertiary EDs included in this study, the overall CTB rate was low with no significant variation between sites when adjusted for ciTBIs.

KEYWORDS:

child; craniocerebral trauma; emergency service, hospital; tomography, X-ray computed

PMID:
31773866
DOI:
10.1111/1742-6723.13396

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