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
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Clinical ImagingAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Traumatic brain injury-related emergency department visits, hospitalizations, and deaths - United States, 2007 and 2013.MMWR Surveill Summ. 2017; 66: 1-16https://doi.org/10.15585/mmwr.ss6609a1
- Incidence of pediatric traumatic brain injury and associated hospital resource utilization in the United States.Pediatrics. 2006; 118: 483-492https://doi.org/10.1542/peds.2005-2588
- Report to congress: the management of traumatic brain injury in children.National Center for Injury Prevention and Control; Division of Unintentional Injury Prevention, Atlanta, GA2018
- Incidence, risk factors and prevention of mild traumatic brain injury: results of the WHO Collaborating Centre Task Force on Mild Traumatic Brain Injury.J Rehabil Med. 2004; : 28-60
- The epidemiology of outpatient visits for minor head injury: 2005 to 2009.Neurosurgery. 2013; 73 (discussion 134): 129-134https://doi.org/10.1227/01.neu.0000429846.14579.41
- Rising use of CT in child visits to the emergency department in the United States, 1995–2008.Radiology. 2011; 259: 793-801https://doi.org/10.1148/radiol.11101939
- Technical report: minor head injury in children.Pediatrics. 1999; 104e78https://doi.org/10.1542/peds.104.6.e78
- Pediatric head trauma: the evidence regarding indications for emergent neuroimaging.Pediatr Radiol. 2008; 38: S670-S674https://doi.org/10.1007/s00247-008-0996-5
- Estimated risks of radiation-induced fatal cancer from pediatric CT.AJR Am J Roentgenol. 2001; 176: 289-296https://doi.org/10.2214/ajr.176.2.1760289
- Report from the pediatric mild traumatic brain injury guideline workgroup: systematic review and clinical recommendations for healthcare providers on the diagnosis and management of mild traumatic brain injury among children.2016
- Centers for Disease Control and Prevention guideline on the diagnosis and Management of Mild Traumatic Brain Injury among Children.JAMA Pediatr. 2018; 172e182853https://doi.org/10.1001/jamapediatrics.2018.2853
- Identification of children at very low risk of clinically-important brain injuries after head trauma: a prospective cohort study.Lancet (London, England). 2009; 374: 1160-1170https://doi.org/10.1016/s0140-6736(09)61558-0
- CATCH: a clinical decision rule for the use of computed tomography in children with minor head injury.CMAJ. 2010; 182: 341-348https://doi.org/10.1503/cmaj.091421
- Derivation of the children's head injury algorithm for the prediction of important clinical events decision rule for head injury in children.Arch Dis Child. 2006; 91: 885-891https://doi.org/10.1136/adc.2005.083980
- Developing a decision instrument to guide computed tomographic imaging of blunt head injury patients.J Trauma. 2005; 59: 954-959https://doi.org/10.1097/01.ta.0000187813.79047.42
- Increased computed tomography utilization in the emergency department and its association with hospital admission.West J Emerg Med. 2017; 18: 835-845https://doi.org/10.5811/westjem.2017.5.34152
- Computed tomography for minor head injury: variation and trends in major United States pediatric emergency departments.J Pediatr. 2012; 160 (e131): 136-139https://doi.org/10.1016/j.jpeds.2011.06.024
- Should a head-injured child receive a head CT scan? A systematic review of clinical prediction rules.Pediatrics. 2009; 124: e145-e154https://doi.org/10.1542/peds.2009-0075
- Variation in ED use of computed tomography for patients with minor head injury.Ann Emerg Med. 1997; 30: 14-22https://doi.org/10.1016/S0196-0644(97)70104-5
- Variation in utilization of computed tomography scanning for the investigation of minor head trauma in children: a Canadian experience.Acad Emerg Med. 2000; 7: 739-744
- Neuroimaging for pediatric head trauma: do patient and hospital characteristics influence who gets imaged?.Acad Emerg Med. 2010; 17: 694-700https://doi.org/10.1111/j.1553-2712.2010.00797.x
- Variation in emergency department head computed tomography use for pediatric head trauma.Acad Emerg Med. 2014; 21: 987-995https://doi.org/10.1111/acem.12458
- Emergency department practice variation in computed tomography use for children with minor blunt head trauma.J Pediatr. 2014; 165 (e1202): 1201-1206https://doi.org/10.1016/j.jpeds.2014.08.008
- National Trauma Data Bank NTDB research data set user manual and variable description list admission years 2002-2016.https://www.facs.org/~/media/files/quality%20programs/trauma/ntdb/ntdb%20rds%20user%20manual%20all%20years.ashxDate accessed: June 29, 2019
- National Trauma Data Bank 2016 annual report.https://www.facs.org/~/media/files/quality%20programs/trauma/ntdb/ntdb%20annual%20report%202016.ashxDate accessed: June 29, 2019
American College of Surgeons. National trauma data standard data dictionary 2015 admissions. The Committee on Trauma. https://www.facs.org/∼/media/files/quality%20programs/trauma/ntdb/ntds/data%20dictionaries/ntds%20data%20dictionary%202015.ashx. Accessed 29 June 2019.
- Traumatic brain injury in the United States: emergency department visits, hospitalizations and deaths 2002–2006.Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Atlanta, GA2010https://www.cdc.gov/traumaticbraininjury/pdf/blue_book.pdfDate accessed: June 29, 2019
- Cranial computed tomography use among children with minor blunt head trauma: association with race/ethnicity.Arch Pediatr Adolesc Med. 2012; 166: 732-737https://doi.org/10.1001/archpediatrics.2012.307
- Recommended framework for presenting injury mortality data.MMWR. 1997; 46: 1-30
- Pediatric head trauma: changes in use of computed tomography in emergency departments in the United States over time.Ann Emerg Med. 2007; 49: 320-324https://doi.org/10.1016/j.annemergmed.2006.09.025
- Variation in computed tomography imaging for pediatric injury-related emergency visits.J Pediatr. 2015; 167 (e893): 897-904https://doi.org/10.1016/j.jpeds.2015.06.052
- Teen trauma without the drama: outcomes of adolescents treated at Ohio adult versus pediatric trauma centers.J Trauma Acute Care Surg. 2014; 77 (discussion 116): 109-116https://doi.org/10.1097/TA.0000000000000277
- Computed tomography rates and estimated radiation-associated cancer risk among injured children treated at different trauma center types.Injury. 2019; 50: 142-148https://doi.org/10.1016/j.injury.2018.09.036
Article info
Publication history
Published online: December 06, 2022
Accepted:
November 29,
2022
Received in revised form:
October 16,
2022
Received:
April 28,
2022
Identification
Copyright
© 2022 Published by Elsevier Inc.
