Pediatric Head Trauma: Changes in Use of Computed Tomography in Emergency Departments in the United States Over Time
Presented at the Society for Pediatric Research, May 2004, San Francisco, CA.
Received 16 June 2006; received in revised form 13 September 2006; accepted 29 September 2006. published online 12 December 2006.
Study objective
Head trauma is common in children. In the absence of evidence-based recommendations, variations exist in the initial emergency department (ED) evaluation and treatment of children with head trauma. We sought to describe the use of computed tomography (CT) over time in the treatment of children with acute closed head trauma in US EDs.
Methods
This was a cross-sectional analysis of data from the National Hospital Ambulatory Care Survey database from 1995 to 2003. We identified patients aged 0 to 18 years, with head trauma by chief complaint or discharge diagnosis. We collected the following data: chief complaint, patient demographics, patient disposition, discharge diagnosis, and use of CT. Frequency and characteristics of the use of CT scan for evaluation of children with head trauma. We used descriptive statistics with appropriate weighting to account for the survey methodology. We determined the frequency and the characteristics of the use of CT scans for evaluation of children with head trauma. We used descriptive statistics with appropriate weighting to account for the survey methodology.
Results
We identified 2,747 patient encounters, representing 10,536,717 pediatric head trauma visits during the 9-year period. The use of CT increased from 12.8% to 22.4% from 1995 to 2003, with a peak of 28.6% in 2000. CT was used more frequently in the older age groups: 13% (<1 year), 11% (1 to 4 years), 20% (5 to 9 years), and 32% (10 to 18 years). CT was also used more frequently in general EDs (22%) than in pediatric-specific EDs (13%). There were no differences in CT use between teaching and nonteaching facilities (21% in each). Overall, 6.4% of children were either admitted to the hospital or transferred, and this rate remained stable over time.
Conclusion
The use of CT has increased substantially in the evaluation of children with head trauma from 1995 to 2003. Further study is needed to identify objective criteria for cranial CT in head-injured children and to evaluate the impact of increased CT use on patient outcomes.
aDepartment of Emergency Medicine, Children's Hospitals and Clinics of Minnesota, Minneapolis, MN (Blackwell)
bthe Department of Pediatrics, Medical College of Wisconsin, Children's Research Institute, Children's Hospital of Wisconsin, Milwaukee, WI (Gorelick)
cthe Departments of Emergency Medicine (Holmes, Kuppermann)
eUniversity of California, Davis School of Medicine, Davis, CA; and the Department of Pediatrics, Emergency Medicine Division, Emory University School of Medicine and Children's Healthcare of Atlanta at Egleston, Atlanta, GA (Bandyopadhyay)
Address for correspondence: Charles D. Blackwell, MD, Children's Hospitals and Clinics of Minnesota, 2525 Chicago Avenue South, Minneapolis, MN 55404; 612-813-6843, fax 612-813-7362;
Supervising editor: Kathy N. Shaw, MD, MSCE
Author contributions: CDB, MG, and NK conceived the study. CDB and MG performed data collection from the NHAMCS database. MG provided statistical advice on study design. CDB and MG performed the main data analysis. JFH, SB, and NK contributed to data analysis and interpretation. CDB drafted the article, and all authors contributed substantially to its revision. CDB takes responsibility for the paper as a whole.
Funding and support: The authors report this study did not receive any outside funding or support.
ABSTRACT