Variation in CT use for paediatric head injuries across different types of emergency departments in Australia and New Zealand

Wilson, Catherine L. and Tavender, Emma J. and Phillips, Natalie T. and Hearps, Stephen J. C. and Foster, Kelly ORCID: https://orcid.org/0000-0002-3328-2177 and O’Brien, Sharon L. and Borland, Meredith L. and Watkins, Gina O. and McLeod, Lorna and Putland, Mark and Priestley, Stephen and Brabyn, Christine and Ballard, Dustin W. and Craig, Simon and Dalziel, Stuart R. and Oakley, Ed and Babl, Franz E. and PREDICT, . (2020) Variation in CT use for paediatric head injuries across different types of emergency departments in Australia and New Zealand. Emergency Medicine Journal, 37 (11). pp. 686-689. ISSN 1472-0205


Abstract

Objectives
CT of the brain (CTB) for paediatric head injury is used less frequently at tertiary paediatric emergency departments (EDs) in Australia and New Zealand than in North America. In preparation for release of a national head injury guideline and given the high variation in CTB use found in North America, we aimed to assess variation in CTB use for paediatric head injury across hospitals types.

Methods
Multicentre retrospective review of presentations to tertiary, urban/suburban and regional/rural EDs in Australia and New Zealand in 2016. Children aged <16 years, with a primary ED diagnosis of head injury were included and data extracted from 100 eligible cases per site. Primary outcome was CTB use adjusted for severity (Glasgow Coma Scale) with 95% CIs; secondary outcomes included hospital length of stay and admission rate.

Results
There were 3072 head injury presentations at 31 EDs: 9 tertiary (n=900), 11 urban/suburban (n=1072) and 11 regional/rural EDs (n=1100). The proportion of children with Glasgow Coma Score ≤13 was 1.3% in each type of hospital. Among all presentations, CTB was performed for 8.2% (95% CI 6.4 to 10.0) in tertiary hospitals, 6.6% (95% CI 5.1 to 8.1) in urban/suburban hospitals and 6.1% (95% CI 4.7 to 7.5) in regional/rural. Intragroup variation of CTB use ranged from 0% to 14%. The regional/rural hospitals admitted fewer patients (14.6%, 95% CI 12.6% to 16.9%, p<0.001) than tertiary and urban/suburban hospitals (28.1%, 95% CI 25.2% to 31.2%; 27.3%, 95% CI 24.7% to 30.1%).

Conclusions
In Australia and New Zealand, there was no difference in CTB use for paediatric patients with head injuries across tertiary, urban/suburban and regional/rural EDs with similar intragroup variation. This information can inform a binational head injury guideline.


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Item Type: Article (Commonwealth Reporting Category C)
Refereed: Yes
Item Status: Live Archive
Faculty/School / Institute/Centre: Current - Faculty of Health, Engineering and Sciences - School of Nursing and Midwifery (1 Jan 2015 -)
Faculty/School / Institute/Centre: Current - Faculty of Health, Engineering and Sciences - School of Nursing and Midwifery (1 Jan 2015 -)
Date Deposited: 08 Dec 2020 06:42
Last Modified: 03 Jan 2021 23:41
Uncontrolled Keywords: emergency departments; guidelines; imaging, CT/MRI; paediatrics, paediatric emergency medicine; trauma, head
Fields of Research (2008): 11 Medical and Health Sciences > 1114 Paediatrics and Reproductive Medicine > 111403 Paediatrics
Fields of Research (2020): 42 HEALTH SCIENCES > 4205 Nursing > 420501 Acute care
Socio-Economic Objectives (2008): C Society > 92 Health > 9205 Specific Population Health (excl. Indigenous Health) > 920501 Child Health
Socio-Economic Objectives (2020): 20 HEALTH > 2005 Specific population health (excl. Indigenous health) > 200506 Neonatal and child health
Identification Number or DOI: https://doi.org/10.1136/emermed-2020-209719
URI: http://eprints.usq.edu.au/id/eprint/40322

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