Martin Gariepy1, Jocelyn Gravel2,3, France Légaré1,4,5, Edward R Melnick6, Erik P Hess7, Holly O Witteman1,4,5, Lania Lelaidier-Hould1, Catherine Truchon8, Louise Sauvé9, Patrick Plante9, Natalie Le Sage1,4,5,10, Patrick M Archambault1,4,5,11,12. 1. Faculty of Medicine, Université Laval, Quebec City, Quebec. 2. Department of Emergency Medicine, CHU Sainte-Justine, Université de Montréal, Montréal, Quebec. 3. Department of Pediatrics, Faculty of Medicine, Université de Montréal, Montréal, Quebec. 4. Centre de recherche sur les soins et les services de premiere ligne de l'Universite Laval (CERSSP-UL), Quebec city, Quebec. 5. Department of Family Medicine and Emergency Medicine, Université Laval, Québec City, Quebec. 6. Department of Emergency Medicine, Yale University, New Haven, Connecticut, USA. 7. Department of Emergency Medicine, Mayo Clinic, Rochester, Minnesota, USA. 8. Institut national d'excellence en santé et services sociaux, Québec, Quebec. 9. Department of Educational Technology, TÉLUQ University, Québec City, Quebec. 10. CHU de Québec - Université Laval Research Centre, Population Health and Optimal Health Practices Research Unit (Trauma-Emergency-Critical Care Medicine), Université Laval, Québec, Quebec. 11. Department of Anesthesiology and Critical Care Medicine, Division of Critical Care Medicine, Université Laval, Québec, Quebec. 12. Centre intégré de santé et services sociaux de Chaudière-Appalaches (site Hôtel-Dieu de Lévis), Lévis, Quebec.
Abstract
BACKGROUND: The validated Pediatric Emergency Care Applied Network (PECARN) rule helps determine the relevance of a head computerized tomography (CT) for children with mild traumatic brain injury (mTBI). We sought to estimate the potential overuse of head CT within two Canadian emergency departments (EDs). METHODS: We conducted a retrospective chart review of children seen in 2016 in a paediatric Level I (site 1) and a general Level II (site 2) trauma centre. We reviewed charts to determine the appropriateness of head CT use according to the PECARN rule in a random subset of children presenting with head trauma. Simple descriptive statistics were applied. RESULTS: One thousand five hundred and forty-six eligible patients younger than 17 years consulted during the study period. Of the 203 randomly selected cases per setting, 16 (7.9%) and 24 (12%), respectively from sites 1 and 2 had a head CT performed. Based on the PECARN rule, we estimated the overuse for the younger group (<2 years) to be below 3% for both hospitals without significant difference between them. For the older group (≥2 years), the overuse rate was higher at site 2 (9.3%, 95% confidence interval [CI]: 4.8 to 17% versus 1.2%, 95% CI: 0.2 to 6.5%, P=0.03). CONCLUSION: Both EDs demonstrated overuse rates below 10% although it was higher for the older group at site 2. Such low rates can potentially be explained by the university affiliation of both hospitals and by two Canadian organizations working to raise awareness among physicians about the overuse of diagnostic tools and dangers inherent to radiation.
BACKGROUND: The validated Pediatric Emergency Care Applied Network (PECARN) rule helps determine the relevance of a head computerized tomography (CT) for children with mild traumatic brain injury (mTBI). We sought to estimate the potential overuse of head CT within two Canadian emergency departments (EDs). METHODS: We conducted a retrospective chart review of children seen in 2016 in a paediatric Level I (site 1) and a general Level II (site 2) trauma centre. We reviewed charts to determine the appropriateness of head CT use according to the PECARN rule in a random subset of children presenting with head trauma. Simple descriptive statistics were applied. RESULTS: One thousand five hundred and forty-six eligible patients younger than 17 years consulted during the study period. Of the 203 randomly selected cases per setting, 16 (7.9%) and 24 (12%), respectively from sites 1 and 2 had a head CT performed. Based on the PECARN rule, we estimated the overuse for the younger group (<2 years) to be below 3% for both hospitals without significant difference between them. For the older group (≥2 years), the overuse rate was higher at site 2 (9.3%, 95% confidence interval [CI]: 4.8 to 17% versus 1.2%, 95% CI: 0.2 to 6.5%, P=0.03). CONCLUSION: Both EDs demonstrated overuse rates below 10% although it was higher for the older group at site 2. Such low rates can potentially be explained by the university affiliation of both hospitals and by two Canadian organizations working to raise awareness among physicians about the overuse of diagnostic tools and dangers inherent to radiation.
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