Purpose: While closed head injuries (CHI) occur commonly in children, most cases do not result in clinically important traumatic brain injury (ciTBI). The 2009 PECARN Pediatric Head Injury algorithm is a well-validated clinical decision guide that enables physicians to safely exclude ciTBIs in children with CHI without obtaining neuroimaging, thus decreasing unnecessary exposure to radiation and other health risks, in addition to healthcare costs. We sought to assess the prevalence of and trends in head CT utilization in children visiting an Emergency Department (ED) with CHI across the United States using a nationally representative sample. Method: We analyzed 2008-2013 data from the Nationwide ED Sample (NEDS) to examine patterns in head CT utilization for children visiting an ED with CHI. All patients < 18 years who visited an ED with CHI were selected. Utilization of head CT was identified using CPT codes. We examined multiple patient and hospital characteristics including the types of injuries. Multivariable logistic regression analysis was used to identify predictors of head CT use in this cohort. Results: From 2008 to 2013, a total of 4,552,071 children visited an ED with CHI, of which 1,181,659 (26%) received a head CT. The majority of these children were treated and released from the ED (97.1%). Rates of head CT utilization per year analyzed were 24.5%, 24.7%, 27%, 26.8%, 25.9% and 26.5%, respectively. Most subjects were males (61.5%) and in the 0-9 year age group (58.6%). Teaching hospitals (THs) (43.7%) treated the majority of children. Females (OR=0.98 [95% CI: 0.96-0.99], p < 0.01) and uninsured children (0.86 [0.82-0.91], p < 0.01) were less likely to receive a head CT. Patients treated in non-teaching hospitals (1.63 [1.35-1.96], p < 0.01) were more likely to receive a head CT. No significant change in annual head CT utilization rates was noted in the years pre- versus post- publication of the PECARN Pediatric Head Injury algorithm (2009) (y2009: OR 1[0.86-1.16]; y2010: 1.1[0.96-1.34]; y2011: OR 1.1[0.92-1.35]; y2012: 1.1[0.94-1.3]; y2013: 1.1[0.92-1.31]; Reference: y2008]. Although head CT utilization rates remained stable in THs, a significant increase was observed in both non-teaching hospitals and suburban hospitals (Figure). Conclusion: In this large nationwide pediatric sample, approximately 1 in 4 children who visited an ED with CHI received a head CT; the vast majority of these children did not require hospital admission or surgical intervention. Children treated at non-teaching hospitals were more likely to receive a head CT, while girls and uninsured children were significantly less likely to undergo head CT. Overall rates of head CT utilization did not decrease after publication of the 2009 PECARN Pediatric Head Trauma algorithm in this sample. In fact, head CT utilization actually increased in suburban hospitals and metropolitan non-teaching hospitals.

Hospital Location/Teaching Status and Use of Head CT Scans by Year

Hospital Location/Teaching Status and Use of Head CT Scans by Year

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