Pediatric Head Trauma: Changes in Use of Computed Tomography in Emergency Departments in the United States Over Time

Charles D. Blackwell, Marc Gorelick, James F. Holmes, Subhankar Bandyopadhyay, Nathan Kuppermann

Research output: Contribution to journalArticle

130 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)320-324
Number of pages5
JournalAnnals of Emergency Medicine
Volume49
Issue number3
DOIs
StatePublished - Mar 1 2007

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Craniocerebral Trauma
Hospital Emergency Service
Tomography
Pediatrics
Closed Head Injuries
Emergency Treatment
Patient Discharge
Ambulatory Care
Teaching
Age Groups
Cross-Sectional Studies
Head
Demography
Databases

All Science Journal Classification (ASJC) codes

  • Emergency Medicine

Cite this

Blackwell, Charles D. ; Gorelick, Marc ; Holmes, James F. ; Bandyopadhyay, Subhankar ; Kuppermann, Nathan. / Pediatric Head Trauma : Changes in Use of Computed Tomography in Emergency Departments in the United States Over Time. In: Annals of Emergency Medicine. 2007 ; Vol. 49, No. 3. pp. 320-324.
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title = "Pediatric Head Trauma: Changes in Use of Computed Tomography in Emergency Departments in the United States Over Time",
abstract = "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.",
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Pediatric Head Trauma : Changes in Use of Computed Tomography in Emergency Departments in the United States Over Time. / Blackwell, Charles D.; Gorelick, Marc; Holmes, James F.; Bandyopadhyay, Subhankar; Kuppermann, Nathan.

In: Annals of Emergency Medicine, Vol. 49, No. 3, 01.03.2007, p. 320-324.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Pediatric Head Trauma

T2 - Changes in Use of Computed Tomography in Emergency Departments in the United States Over Time

AU - Blackwell, Charles D.

AU - Gorelick, Marc

AU - Holmes, James F.

AU - Bandyopadhyay, Subhankar

AU - Kuppermann, Nathan

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N2 - 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.

AB - 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.

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