Noam Gerber1, Kelley Sookraj2, Swapna Munnangi2, L D George Angus2, Vineet Lamba3, Krishan Kumar3, Brinda Doraiswamy3. 1. Department of Surgery, Nassau University Medical Center, 2201 Hempstead Turnpike, East Meadow, NY, 11554, USA. ngerber@numc.edu. 2. Department of Surgery, Nassau University Medical Center, 2201 Hempstead Turnpike, East Meadow, NY, 11554, USA. 3. Department of Pediatrics, Nassau University Medical Center, 2201 Hempstead Turnpike, East Meadow, NY, 11554, USA.
Abstract
PURPOSE: To evaluate whether the emergency department usage of head computed tomography (CT) on pediatric patients with minor head trauma changed after publication of the Pediatric Emergency Care Applied Research Network (PECARN) head CT guidelines and to identify risk factors associated with performing head CT on patients without a PECARN guideline indication. METHODS: This retrospective study included 484 patients 18 years of age or younger who presented to the emergency department with head injury and a total Glasgow Coma Scale score ≥ 14 between September 2005 and July 2014. Based on the guideline publication date of September 2009, the study cohort was stratified into pre-guideline and post-guideline groups. Head CT performance, indications, and findings were compared between study periods. Logistic regression was used to identify risk factors associated with performing a non-indicated head CT. RESULTS: The rate of head CTs performed did not significantly change in the post-guideline period (96.6% vs. 95.7%, p = 0.63). There was no significant difference in the proportion of head CTs performed in patients with indications for head CT (100.0% vs. 100.0%) nor in patients without an indication for head CT (85.7% vs. 82.6%, p = 0.65) between the study periods. Females were significantly more likely to have a non-indicated head CT (OR: 2.73, 95% CI: 1.67-4.45) performed. CONCLUSIONS: Head CT ordering practices for pediatric patients with head injury did not change at a level I trauma center after publication of the PECARN head CT guidelines.
PURPOSE: To evaluate whether the emergency department usage of head computed tomography (CT) on pediatric patients with minor head trauma changed after publication of the Pediatric Emergency Care Applied Research Network (PECARN) head CT guidelines and to identify risk factors associated with performing head CT on patients without a PECARN guideline indication. METHODS: This retrospective study included 484 patients 18 years of age or younger who presented to the emergency department with head injury and a total Glasgow Coma Scale score ≥ 14 between September 2005 and July 2014. Based on the guideline publication date of September 2009, the study cohort was stratified into pre-guideline and post-guideline groups. Head CT performance, indications, and findings were compared between study periods. Logistic regression was used to identify risk factors associated with performing a non-indicated head CT. RESULTS: The rate of head CTs performed did not significantly change in the post-guideline period (96.6% vs. 95.7%, p = 0.63). There was no significant difference in the proportion of head CTs performed in patients with indications for head CT (100.0% vs. 100.0%) nor in patients without an indication for head CT (85.7% vs. 82.6%, p = 0.65) between the study periods. Females were significantly more likely to have a non-indicated head CT (OR: 2.73, 95% CI: 1.67-4.45) performed. CONCLUSIONS: Head CT ordering practices for pediatric patients with head injury did not change at a level I trauma center after publication of the PECARN head CT guidelines.
Entities:
Keywords:
Children; Computed tomography; Emergency medicine; Head injury; PECARN; Trauma
Authors: Adam P Sigal; Traci Deaner; Sam Woods; Elizabeth Mannarelli; Alison L Muller; Anthony Martin; Alexis Schoener; McKenna Brower; Adrian Ong; Thomas Geng; Felipe Guillen; Brian Lahmann; Tom Wasser; Christopher Valente Journal: J Am Coll Emerg Physicians Open Date: 2022-01-15