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Trauma center variation of head computed tomography utilization in children presenting with mild traumatic brain injury

Published:December 06, 2022DOI:https://doi.org/10.1016/j.clinimag.2022.11.024

      Highlights

      • Prior studies on variation in CT usage between trauma centers are not generalizable to children presenting with mild traumatic brain injury
      • ACS verified adult-only trauma centers are more likely to administer head CT on pediatric mTBI loss of conscious patients. This is a novel finding and an important contribution to the literature.

      Abstract

      Background

      Although published clinical decision rules have identified indications for the use of head CT in children with mild traumatic brain injury, practices vary.

      Objective

      This study seeks to evaluate whether the utilization of head CT in pediatric trauma patients presenting with mTBI varies between American College of Surgeons verified pediatric trauma centers (ACS-PTC) and adult-only trauma centers (ACS-AOTC).

      Material and methods

      A retrospective cohort study of 24,104 trauma patients, ≤17, who presented to the emergency department at 337 ACS verified level I/II trauma centers with isolated mTBI was conducted using National Trauma Data Bank records (2011–2015). Multivariable logistic regression was used to compare the odds of a patient receiving a head CT when treated at an ACS-PTC vs. an ACS-AOTC, controlling for demographic, injury, and hospital-level confounders. Effect modification by loss of consciousness was assessed and adjusted head CT odds were recalculated in patients stratified by LOC status.

      Results

      There was no significant difference in the adjusted odds of receiving a head CT at an ACS-PTC vs. an ACS-AOTC (odds ratio: 0.98, 95% confidence interval: 0.92–1.04). However, in patients who had a LOC, the adjusted OR of receiving a head CT at an ACS-PTC vs ACS-AOTC was 0.71 (95% confidence interval: 0.65–0.78).

      Conclusion

      Children presenting to the emergency department of an ACS-verified level I or II trauma center with mTBI who had a loss of consciousness are less likely to receive a head CT at an ACS verified pediatric trauma center than at an ACS verified adult-only trauma center.

      Keywords

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