The effect of observation on cranial computed tomography utilization for children after blunt head trauma

Lise E. Nigrovic, Jeff E. Schunk, Adele Foerster, Arthur Cooper, Michelle Miskin, Shireen M. Atabaki, John Hoyle, Peter S. Dayan, James F Holmes Jr, Nathan Kuppermann

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73 Scopus citations

Abstract

OBJECTIVE: Children with minor blunt head trauma often are observed in the emergency department before a decision is made regarding computed tomography use. We studied the impact of this clinical strategy on computed tomography use and outcomes. METHODS: We performed a subanalysis of a prospective multicenter observational study of children with minor blunt head trauma. Clinicians completed case report forms indicating whether the child was observed before making a decision regarding computed tomography. We defined clinically important traumatic brain injury as an intracranial injury resulting in death, neurosurgical intervention, intubation for longer than 24 hours, or hospital admission for 2 nights or longer. To compare computed tomography rates between children observed and those not observed before a decision was made regarding computed tomography use, we used a generalized estimating equation model to control for hospital clustering and patient characteristics. RESULTS: Of 42 412 children enrolled in the study, clinicians noted if the patient was observed before making a decision on computed tomography in 40 113 (95%). Of these, 5433 (14%) children were observed. The computed tomography use rate was lower in those observed than in those not observed (31.1% vs 35.0%; difference: -3.9% [95% confidence interval: -5.3 to -2.6]), but the rate of clinically important traumatic brain injury was similar (0.75% vs 0.87%; difference: -0.1% [95% confidence interval: -0.4 to 0.1]). After adjustment for hospital and patient characteristics, the difference in the computed tomography use rate remained significant (adjusted odds ratio for obtaining a computed tomography in the observed group: 0.53 [95% confidence interval: 0.43-0.66]). CONCLUSIONS: Clinical observation was associated with reduced computed tomography use among children with minor blunt head trauma and may be an effective strategy to reduce computed tomography use.

Original languageEnglish (US)
Pages (from-to)1067-1073
Number of pages7
JournalPediatrics
Volume127
Issue number6
DOIs
StatePublished - Jun 2011

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Keywords

  • Clinical observation
  • Computed tomography
  • Traumatic brain injury

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Nigrovic, L. E., Schunk, J. E., Foerster, A., Cooper, A., Miskin, M., Atabaki, S. M., Hoyle, J., Dayan, P. S., Holmes Jr, J. F., & Kuppermann, N. (2011). The effect of observation on cranial computed tomography utilization for children after blunt head trauma. Pediatrics, 127(6), 1067-1073. https://doi.org/10.1542/peds.2010-3373