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J Pediatr. 2014 Dec;165(6):1201-1206.e2. doi: 10.1016/j.jpeds.2014.08.008. Epub 2014 Oct 5.

Emergency department practice variation in computed tomography use for children with minor blunt head trauma.

Author information

1
Department of Emergency Medicine and Pediatrics, University of Michigan, Ann Arbor, MI. Electronic address: stanleyr@umich.edu.
2
Division of Emergency Medicine, Michigan State University College of Human Medicine, Helen DeVos Children's Hospital, Grand Rapids, MI.
3
Department of Pediatrics, Columbia University College of Physicians and Surgeons, New York, NY.
4
Department of Emergency Medicine, Children's National Medical Center, George Washington School of Medicine, Washington, DC.
5
Department of Pediatrics, Harvard Medical School, Boston, MA.
6
Department of Pediatrics, State University of New York at Buffalo and Women and Children's Hospital of Buffalo, Buffalo, NY.
7
Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI.
8
Department of Pediatrics, University of Utah and PECARN Data Coordinating Center, Salt Lake City, UT.
9
Department of Emergency Medicine, University of California Davis School of Medicine, Davis, CA.

Abstract

OBJECTIVE:

To describe factors associated with computed tomography (CT) use for children with minor blunt head trauma that are evaluated in emergency departments.

STUDY DESIGN:

Planned secondary analysis of a prospective observational study of children <18 years with minor blunt head trauma between 2004 and 2006 at 25 emergency departments. CT scans were obtained at the discretion of treating clinicians. We risk-adjusted patients for clinically important traumatic brain injuries and performed multivariable regression analyses. Outcome measures were rates of CT use by hospital and by clinician training type.

RESULTS:

CT rates varied between 19.2% and 69.2% across hospitals. Risk adjustment had little effect on the differential rate of CT use. In low- and middle-risk patients, clinicians obtained CTs more frequently at suburban and nonfreestanding children's hospitals. Physicians with emergency medicine (EM) residency training obtained CTs at greater rates than physicians with pediatric residency or pediatric EM training. In multivariable analyses, compared with pediatric EM-trained physicians, the OR for CT use among EM-trained physicians in children <2 years was 1.24 (95% CI 1.04-1.46), and for children >2 years was 1.68 (95% CI 1.50-1.89). Physicians of all training backgrounds, however, overused CT scans in low-risk children.

CONCLUSIONS:

Substantial variation exists in the use of CT for children with minor blunt head trauma not explained by patient severity or rates of positive CT scans or clinically important traumatic brain injuries.

PMID:
25294604
DOI:
10.1016/j.jpeds.2014.08.008
[Indexed for MEDLINE]

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