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Computed Tomography Imaging in Children with Head Trauma: Utilization and Appropriateness from a Quality Improvement Perspective

Published online by Cambridge University Press:  21 June 2016

Montserrat Vera ,
Gary R. Fleisher ,
Patrick D. Barnes ,
Bruce H. Bjornson ,
Elizabeth N. Allred  and
Donald A. Goldmann
Montserrat Vera
Affiliation:
Hospital Epidemiology and Quality Improvement, Children's Hospital, Harvard Medical School, Boston, Massachusetts
Gary R. Fleisher
Affiliation:
Emergency Department, Children's Hospital, Harvard Medical School, Boston, Massachusetts
Patrick D. Barnes
Affiliation:
Radiology Department, Children's Hospital, Harvard Medical School, Boston, Massachusetts
Bruce H. Bjornson
Affiliation:
Neurology Department, Children's Hospital, Harvard Medical School, Boston, Massachusetts
Elizabeth N. Allred
Affiliation:
Neuroepidemiology Unit, Children's Hospital, Harvard Medical School, Boston, Massachusetts
Donald A. Goldmann*
Affiliation:
Hospital Epidemiology and Quality Improvement, Children's Hospital, Harvard Medical School, Boston, Massachusetts
*
Hospital Epidemiology and Quality improvement, Children’s Hospital, 300 Longwood Avenue, Enders 609, Boston, MA 02115
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Abstract

Computed tomography (CT) imaging plays an important role in the acute evaluation and management of children with head trauma. When routine quality improvement (QI) meetings with representatives from the Children’s Hospital radiology and emergency departments revealed disagreement regarding the utilization and appropriateness of CT in children presenting with head trauma, an interdepartmental QI team was formed to address this issue. Because formal criteria for obtaining CTs for head trauma were unavailable, internal institutional criteria were developed by consensus after literature review. Contrary to perceptions of some staff members, the majority (95%) of children who received CT met at least one of the established criteria over a one-year study period. There was little relationship between the presence of criteria and abnormal CT results, but decisions whether to admit patients to the hospital or to send them home were influenced by CT results. Follow-up studies suggested that patients who were discharged home with a normal CT or no CT had uniformly good outcomes.

Type
Beyond Infection Control: The New Hospital Epidemiology
Information
Infection Control & Hospital Epidemiology , Volume 14 , Issue 8 , August 1993 , pp. 491 - 499
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1993

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References

1. Tecklenburg, F, Wright, M. Minor head trauma in the pediatric patient. Pediatr Emerg Cure 1991;7:40–47.CrossRefGoogle ScholarPubMed
2. Rosenthal, B, Bergman, I. Intracranial injury after moderate head trauma in children. J Pediatr 1989;115:346–350.CrossRefGoogle ScholarPubMed
3. Yealy, DM, Hogan, DE. Imaging after head trauma. Who needs that? Emerg Med Clin North Am 1991;9:707–717.CrossRefGoogle Scholar
4. Mohanty, SK, Thompson, W, Rakower, S. Are CT scans for head injury patients always necessary? J Trauma 1991;31:801–804.CrossRefGoogle ScholarPubMed
5. Stein, SC, O'Malley, KE Ross, SE. Is routine computed tomography scanning too expensive for mild head injury? Ann Emerg Med 1991;20:1286–1289.CrossRefGoogle ScholarPubMed
6. Rivara, E Tanaguchi, D, Parish, RA, Stimac, GK, Mueller, B. Poor prediction of positive computed tomographic scans by clinical criteria in symptomatic pediatric head trauma. Pediatrics 1987;80:579–584.CrossRefGoogle ScholarPubMed
7. Hennes, H, Lee, M, Smith, D, Sty, JR, Losek, J. Clinical predictors of severe head trauma in children. Am J Dis Child 1988;142:1045–1047.Google ScholarPubMed
8. Waxman, K, Sundine, MJ, Young, RE. Is early prediction of outcome in severe head injury possible? Arch Surg 1991;126:1237–1241.CrossRefGoogle ScholarPubMed
9. Reilly, PL, Simpson, DA, Sprod, R, Thomas, L. Assessing the conscious level in infants and young children: a paediatric version of the Glasgow Coma Scale. Childs Nem Syst 1988;4:30–33.Google ScholarPubMed
10. Simpson, DA, Cockington, RA, Hanieh, A, Raffos, J, Reilly, PL. Head injuries in infants and young children: the value of the Paediatric Coma Scale. Childs Nerv Syst 1991;7:183–190.CrossRefGoogle ScholarPubMed
11. International Classification of Diseases. 9th rev., vol 1, 2nd ed. Washington, DC: US Public Health Service, HCFA; 1980. DHHS publication (PHS) 80–1260.Google Scholar
12. Berwick, DM. Continuous improvement as an ideal in healthcare. N Engl J Med 1989;320:53–56.CrossRefGoogle Scholar
13. Laffel, G, Blumenthal, D. The case for using industrial quality management in health care organizations. JAMA 1989;262:2869–2873.CrossRefGoogle ScholarPubMed