Comparison of minor head trauma management in the emergency departments of a United States and Italian Children\u2019s hospital

Brittany M Stopa,Stefano Amoroso,Lois K Lee,Luca Ronfani,Elena Neri,Egidio Barbi

doi:10.1186/s13052-019-0615-0

Abstract

BackgroundPediatric head trauma management varies between emergency departments globally. Here we aim to compare the pediatric minor head trauma management between a US and Italian hospital.MethodsWe conducted a retrospective chart review of children 0–18 years old presenting after minor head trauma (Glasgow Coma Scale 14–15) from two emergency departments, in Boston, Massachusetts, United States and Trieste, Italy, between January and December 2013. Frequencies of demographic, clinical, and management characteristic were calculated. We compared rate ratios for characteristics of patients receiving cranial computed tomography (CT) scans between the two populations.ResultsThere were 1783 patients in Boston, Massachusetts and 183 patients in Trieste, Italy. Patients in Boston had more reported neurologic symptoms (61.2%) than in Trieste (6%) (p < 0.001). More CT scans were ordered on the patients in Boston (17.3% vs. 6.6%) (p < 0.001), while more children were hospitalized in Trieste (55.7% vs. 8.6%) (p < 0.001). Patients with neurological symptoms more commonly had a CT scan in Trieste (45.5%) than in Boston (23.5%) (RR 0.52, 95% CI 0.27, 1.00), while more patients without neurological symptoms had CTs in Boston (7.5%) than in Trieste (4.1%) (RR 1.85, 95% CI 0.86, 4.00). Assignment of triage levels and definitions of head injury severity varied considerably between the two hospitals, resulting in dissimilar populations presenting to the two hospitals, and thus, differences in the management of these children.ConclusionThe population of head trauma patients and the management of pediatric minor head trauma differs between Boston and Trieste, with a preference for CT scans in Boston and a preference for hospitalization in Trieste. Clinical guidelines used at each institution likely lead to this variation in care influenced by the different patient populations and institutional resources.

Highlights

Pediatric head trauma management varies between emergency departments globally
As international consensus on pediatric head trauma management has not been reached, these guidelines are utilized by different hospitals and trauma care facilities internationally to aid in managing pediatric head trauma patients [15,16,17,18,19]
During the one-year study period, there were 1966 patients in the total study sample who were evaluated for minor head trauma: 1783 children in Boston and 183 children in Trieste

Summary

Introduction

Pediatric head trauma management varies between emergency departments globally. Here we aim to compare the pediatric minor head trauma management between a US and Italian hospital. To guide the clinician in the clinical decision-making in the evaluation of pediatric head trauma, several guidelines have been developed. As international consensus on pediatric head trauma management has not been reached, these guidelines are utilized by different hospitals and trauma care facilities internationally to aid in managing pediatric head trauma patients [15,16,17,18,19]. This may be due to differences in mechanisms of injury and severity of head trauma presenting to different hospitals, as well as different clinical preferences and hospital resources [19]

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