Results from a retrospective analysis found that although rates of computed tomography (CT) scans have declined following the publication of the Pediatric Emergency Care Applied Research Network (PECARN) blunt head trauma guidelines, there appears to be no evidence that this decline was a direct result of this publication or the implementation of urgent neurology follow-up appointments. Findings from the study were published in Pediatric Emergency Care.
The study investigators retrospectively analyzed patients age 0 to 18 who presented to and were discharged from a tertiary care pediatric emergency department (PED) between 2007 and 2013. Complaints at presentation were related to trauma, headache, and seizure. The total number of head CT scans in the trauma, headache, and seizure groups was compared prior to and after PECARN guideline publication in 2009, as well as after urgent neurology follow-ups within a 1-week period from PED discharge in 2011.
Of the 24,434 admissions to the care center that were retrospectively identified, a total of 2762 head CTs were performed. Following the publication of the PECARN guidelines on blunt head trauma, there was an observable reduction in pediatric head CTs for trauma (odds ratio [OR], 2.0; 95% CI, 1.8-2.2). In addition, there was a decline in pediatric head CTs for headache (OR, 1.4; 95% CI, 1.1-1.8) and seizure (OR, 1.9; 95% CI, 1.4-2.6) with urgent neurology follow-up appointments following PECARN publication. Rates of CTs for seizures appeared to decline before the implementation of urgent neurology follow-up appointments (β= −0.6% per quarter; 95% CI, −0.2% to −1.0%) but not after the implementation (β=0.4% per quarter; 95% CI, −0.1% to 0.9%).
Limitations of the study include the retrospective nature of the analysis, the inclusion of data from patients attending a single center, and the lack of generalizability of the findings for adult patients.
The researchers added that “a prospective study evaluating provider assessment that results in ordering head CTs in at risk pediatric groups (trauma, seizure, headache) may determine the next best steps to reduce the rates of unnecessary head CTs.”
Jolley DL, Upham B, Fullerton L, Annett RD. Reduction in head computed tomography ordering in pediatric emergency patients: effect of national publication and local availability of urgent neurology appointments [published online February 8, 2019]. Pediatr Emerg Care. doi:10.1097/PEC.0000000000001757