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. 2012 Jan;160(1):136-9.e1.
doi: 10.1016/j.jpeds.2011.06.024. Epub 2011 Aug 2.

Computed tomography for minor head injury: variation and trends in major United States pediatric emergency departments

Rebekah Mannix  1 , William P Meehan, Michael C Monuteaux, Richard G Bachur
Affiliations

Computed tomography for minor head injury: variation and trends in major United States pediatric emergency departments

Rebekah Mannix et al. J Pediatr. 2012 Jan.

Abstract

Objectives: To investigate the variation and trends in neuroimaging in children examined for minor head injury at major US pediatric emergency departments.

Study design: We conducted a retrospective study of children <19 years of age with mild head injury who were examined and discharged home from the emergency department at 40 pediatric hospitals from 2005 to 2009 by using the Pediatric Health Information Systems database. Variation in computed tomography (CT) rates between hospitals was assessed for correlation with hospital-specific rates of intracranial hemorrhage, admission, and return visits. Age-adjusted trends in CT use were calculated for the 5 years.

Results: In the 5 years, the median rate of imaging for minor head injured patients was 36% (IQR, 29%-42%; range, 19%-58%). There was no correlation between institution-specific rates of CT imaging and intracranial hemorrhage, admission, or return-visit rates. Age-adjusted rates of CT use decreased in the 5-year period (OR, 0.94; 95% CI, 0.92-0.97; P < .001).

Conclusions: In this study, we found significant practice variation in CT use at pediatric hospitals examining children with minor head injury. These data may help guide national benchmarks for the appropriate use of CT imaging in pediatric patients with minor head injury.

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Conflict of interest statement

The authors declare no conflicts of interest

Figures

Figure 1
Figure 1
Rates of CT in pediatric patients with minor head injury discharged from the ED (n=161,319), across a sample of pediatric hospitals in the US from 2005–2009
Figure 2
Figure 2
Significant head injury (SHI) as a proportion of all ED visits across a sample of pediatric hospitals in the US from 2005–2009
Figure 3
Figure 3
Association between rates of imaging of pediatric patients discharged from the ED with minor head injury (n=159,322) and rates of subsequent ED visits across a sample of pediatric hospitals in the U.S., 2005–2009
See this image and copyright information in PMC

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