Variation in CT use for paediatric head injuries across different types of emergency departments in Australia and New Zealand

Catherine L Wilson^{1

2}, Emma J Tavender^{1

3}, Natalie T Phillips^{4

5}, Stephen Jc Hearps⁶, Kelly Foster^{2

7}, Sharon L O'Brien^{8

9}, Meredith L Borland^{10

11}, Gina O Watkins^{2

12}, Lorna McLeod¹³, Mark Putland¹⁴, Stephen Priestley¹⁵, Christine Brabyn¹⁶, Dustin W Ballard¹⁷, Simon Craig^{18

19}, Stuart R Dalziel^{20

21}, Ed Oakley^{3

22}, Franz E Babl^{23

22

24}; Paediatric Research in Emergency Department's International Collaborative

Collaborators, Affiliations

Collaborators

Paediatric Research in Emergency Department's International Collaborative:
Jamie Lew, Stephen Teo, Amie Beattie, Mary McCaskill, Arjun Rao, Jo Cole, Adam Michael, Shane George, Alex King, Corey Cassidy, Frances Kinnear Ben Lawton, Amit Kochar, Lalith Gamage, Peter Archer, Ashes Mukherjee, Russell Young, Hugh Mitenko

Affiliations

¹ Emergency Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia.
² Paediatric Research in Emergency Departments International Collaborative, Murdoch Children's Research Institute, Parkville, Victoria, Australia.
³ Paediatrics, University of Melbourne, Parkville, Victoria, Australia.
⁴ Emergency Department, Queensland Children's Hospital, South Brisbane, Queensland, Australia.
⁵ Child Health Research Centre, University of Queensland, Brisbane, Queensland, Australia.
⁶ Clinical Sciences, Murdoch Childrens Research Institute, Parkville, Victoria, Australia.
⁷ School of Nursing and Midwifery, University of Southern Queensland, Ipswich, Queensland, Australia.
⁸ Emergency, Perth Children's Hospital, Nedlands, Western Australia, Australia.
⁹ School of Nursing, Midwifery & Paramedicine, Curtin University, Perth, Western Australia, Australia.
¹⁰ Emergency Department, Perth Children's Hospital, Perth, Western Australia, Australia.
¹¹ Divisions of Paediatrics and Emergency Medicine, School of Medicine, The University of Western Australia, Perth, Western Australia, Australia.
¹² Emergency Department, Sutherland Hospital, Caringbah, New South Wales, Australia.
¹³ Emergency Department, Coffs Harbour Base Hospital, Coffs Harbour, New South Wales, Australia.
¹⁴ Emergency Department, Bendigo Health-Bendigo Hospital Campus, Bendigo, Victoria, Australia.
¹⁵ Emergency Department, Sunshine Coast University Hospital, Sunshine Coast, Queensland, Australia.
¹⁶ Emergency Department, Waikato District Health Board, Hamilton, New Zealand.
¹⁷ Northern California Division of Research, Kaiser Permanente, Oakland, California, USA.
¹⁸ Emergency Department, Monash Medical Centre Clayton, Clayton, Victoria, Australia.
¹⁹ Department of Paediatrics, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia.
²⁰ Emergency Department, Starship Children's Health, Auckland, New Zealand.
²¹ Departments of Surgery and Paediatrics: Child and Youth Health, The University of Auckland, Auckland, Auckland, New Zealand.
²² Emergency Department, Royal Children's Hospital, Parkville, Victoria, Australia.
²³ Emergency Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia franz.babl@rch.org.au.
²⁴ Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia.

PMID: 32816840
DOI: 10.1136/emermed-2020-209719

Multicenter Study

Variation in CT use for paediatric head injuries across different types of emergency departments in Australia and New Zealand

Catherine L Wilson et al. Emerg Med J. 2020 Nov.

. 2020 Nov;37(11):686-689.

doi: 10.1136/emermed-2020-209719. Epub 2020 Aug 17.

Authors

Collaborators

Paediatric Research in Emergency Department's International Collaborative:
Jamie Lew, Stephen Teo, Amie Beattie, Mary McCaskill, Arjun Rao, Jo Cole, Adam Michael, Shane George, Alex King, Corey Cassidy, Frances Kinnear Ben Lawton, Amit Kochar, Lalith Gamage, Peter Archer, Ashes Mukherjee, Russell Young, Hugh Mitenko

Affiliations

¹ Emergency Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia.
² Paediatric Research in Emergency Departments International Collaborative, Murdoch Children's Research Institute, Parkville, Victoria, Australia.
³ Paediatrics, University of Melbourne, Parkville, Victoria, Australia.
⁴ Emergency Department, Queensland Children's Hospital, South Brisbane, Queensland, Australia.
⁵ Child Health Research Centre, University of Queensland, Brisbane, Queensland, Australia.
⁶ Clinical Sciences, Murdoch Childrens Research Institute, Parkville, Victoria, Australia.
⁷ School of Nursing and Midwifery, University of Southern Queensland, Ipswich, Queensland, Australia.
⁸ Emergency, Perth Children's Hospital, Nedlands, Western Australia, Australia.
⁹ School of Nursing, Midwifery & Paramedicine, Curtin University, Perth, Western Australia, Australia.
¹⁰ Emergency Department, Perth Children's Hospital, Perth, Western Australia, Australia.
¹¹ Divisions of Paediatrics and Emergency Medicine, School of Medicine, The University of Western Australia, Perth, Western Australia, Australia.
¹² Emergency Department, Sutherland Hospital, Caringbah, New South Wales, Australia.
¹³ Emergency Department, Coffs Harbour Base Hospital, Coffs Harbour, New South Wales, Australia.
¹⁴ Emergency Department, Bendigo Health-Bendigo Hospital Campus, Bendigo, Victoria, Australia.
¹⁵ Emergency Department, Sunshine Coast University Hospital, Sunshine Coast, Queensland, Australia.
¹⁶ Emergency Department, Waikato District Health Board, Hamilton, New Zealand.
¹⁷ Northern California Division of Research, Kaiser Permanente, Oakland, California, USA.
¹⁸ Emergency Department, Monash Medical Centre Clayton, Clayton, Victoria, Australia.
¹⁹ Department of Paediatrics, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia.
²⁰ Emergency Department, Starship Children's Health, Auckland, New Zealand.
²¹ Departments of Surgery and Paediatrics: Child and Youth Health, The University of Auckland, Auckland, Auckland, New Zealand.
²² Emergency Department, Royal Children's Hospital, Parkville, Victoria, Australia.
²³ Emergency Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia franz.babl@rch.org.au.
²⁴ Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia.

PMID: 32816840
DOI: 10.1136/emermed-2020-209719

Abstract

Objectives: CT of the brain (CTB) for paediatric head injury is used less frequently at tertiary paediatric emergency departments (EDs) in Australia and New Zealand than in North America. In preparation for release of a national head injury guideline and given the high variation in CTB use found in North America, we aimed to assess variation in CTB use for paediatric head injury across hospitals types.

Methods: Multicentre retrospective review of presentations to tertiary, urban/suburban and regional/rural EDs in Australia and New Zealand in 2016. Children aged <16 years, with a primary ED diagnosis of head injury were included and data extracted from 100 eligible cases per site. Primary outcome was CTB use adjusted for severity (Glasgow Coma Scale) with 95% CIs; secondary outcomes included hospital length of stay and admission rate.

Results: There were 3072 head injury presentations at 31 EDs: 9 tertiary (n=900), 11 urban/suburban (n=1072) and 11 regional/rural EDs (n=1100). The proportion of children with Glasgow Coma Score ≤13 was 1.3% in each type of hospital. Among all presentations, CTB was performed for 8.2% (95% CI 6.4 to 10.0) in tertiary hospitals, 6.6% (95% CI 5.1 to 8.1) in urban/suburban hospitals and 6.1% (95% CI 4.7 to 7.5) in regional/rural. Intragroup variation of CTB use ranged from 0% to 14%. The regional/rural hospitals admitted fewer patients (14.6%, 95% CI 12.6% to 16.9%, p<0.001) than tertiary and urban/suburban hospitals (28.1%, 95% CI 25.2% to 31.2%; 27.3%, 95% CI 24.7% to 30.1%).

Conclusions: In Australia and New Zealand, there was no difference in CTB use for paediatric patients with head injuries across tertiary, urban/suburban and regional/rural EDs with similar intragroup variation. This information can inform a binational head injury guideline.

Keywords: emergency departments; guidelines; imaging, CT/MRI; paediatrics, paediatric emergency medicine; trauma, head.

PubMed Disclaimer

Conflict of interest statement

Competing interests: None declared.

Publication types

Actions

MeSH terms

Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions

LinkOut - more resources

Full Text Sources
- HighWire
- Ovid Technologies, Inc.
Medical
- MedlinePlus Consumer Health Information
- MedlinePlus Health Information

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

Variation in CT use for paediatric head injuries across different types of emergency departments in Australia and New Zealand

Collaborators

Affiliations

Variation in CT use for paediatric head injuries across different types of emergency departments in Australia and New Zealand

Authors

Collaborators

Affiliations

Abstract

Conflict of interest statement

Publication types

MeSH terms

LinkOut - more resources

Full Text Sources

Medical