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

Article

Wilson, Catherine L., Tavender, Emma J., Phillips, Natalie T., Hearps, Stephen J. C., Foster, Kelly, O’Brien, Sharon L., Borland, Meredith L., Watkins, Gina O., McLeod, Lorna, Putland, Mark, Priestley, Stephen, Brabyn, Christine, Ballard, Dustin W., Craig, Simon, Dalziel, Stuart R., Oakley, Ed and Babl, Franz E.. 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. https://doi.org/10.1136/emermed-2020-209719
Article Title

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

ERA Journal ID16048
Article CategoryArticle
AuthorsWilson, Catherine L. (Author), Tavender, Emma J. (Author), Phillips, Natalie T. (Author), Hearps, Stephen J. C. (Author), Foster, Kelly (Author), O’Brien, Sharon L. (Author), Borland, Meredith L. (Author), Watkins, Gina O. (Author), McLeod, Lorna (Author), Putland, Mark (Author), Priestley, Stephen (Author), Brabyn, Christine (Author), Ballard, Dustin W. (Author), Craig, Simon (Author), Dalziel, Stuart R. (Author), Oakley, Ed (Author) and Babl, Franz E. (Author)
Journal TitleEmergency Medicine Journal
Journal Citation37 (11), pp. 686-689
Number of Pages4
Year2020
Place of PublicationUnited Kingdom
ISSN1472-0205
1472-0213
Digital Object Identifier (DOI)https://doi.org/10.1136/emermed-2020-209719
Web Address (URL)https://emj.bmj.com/content/37/11/686.long
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.

Keywordsemergency departments; guidelines; imaging, CT/MRI; paediatrics, paediatric emergency medicine; trauma, head
ANZSRC Field of Research 2020420501. Acute care
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Institution of OriginUniversity of Southern Queensland
Byline AffiliationsMurdoch Children's Research Institute, Australia
University of Queensland
School of Nursing and Midwifery
Curtin University
University of Western Australia
Department of Health, New South Wales
Department of Health, Victoria
University of the Sunshine Coast
Waikato District Health Board, New Zealand
Northern California Division of Research, United States
Starship Children's Hospital, New Zealand
University of Melbourne
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