Abstract
BackgroundComputed tomography (CT) is commonly used in children with mild head injuries. People in Japan are concerned about radiation exposure and radiation-induced cancer because of the Fukushima Daiichi Nuclear Power Plant accident on March 11, 2011. This study investigated whether the accident influenced the use of CT in children with mild head injuries.MethodsUsing the Japan Medical Data Center database, we identified patients aged ≤15 years visiting hospitals because of mild head injuries from January 1, 2008, to December 31, 2013. We excluded patients who were admitted to the hospital or received other medical examinations. Regression discontinuity analysis was used to compare proportions of patients undergoing head CT and having clinically important traumatic brain injury (ciTBI) overlooked before versus after the accident, adjusting for patient characteristics, secular trends, and hospital effect.ResultsEligible patients (n = 40,440) were classified as visiting the hospital before (n = 11,659) or after (n = 28,781) the accident. The regression discontinuity analysis showed that the accident was associated with a reduction in the proportion of patients undergoing head CT (odds ratio [OR] 0.73; 95% confidence interval [CI], 0.63–0.86), whereas the accident was not associated with an increase in cases where ciTBI was overlooked (OR 0.72; 95% CI, 0.13–4.00).ConclusionsThe use of CT in children with mild head injuries declined after the Fukushima Daiichi Nuclear Power Plant accident. Improving awareness of radiation exposure risks among patients and physicians could reduce unnecessary CT.
Highlights
A previous report showed that Computed tomography (CT) examination was routinely used in the United States, even in cases of mild head injury.[6]
Patient selection and outcome We identified outpatients aged 15 years or younger who were diagnosed with superficial scalp injury (S00.0), contusion of eyelid and periocular area (S00.1), other superficial injuries of eyelid and periocular area (S00.2), multiple superficial head injuries (S00.7), concussion (S06.0), or unspecified head injury (S09.9)
The crude proportion undergoing CT differed for patients visiting hospitals before versus after the accident (35.4% vs 33.2%, difference: −2.1%; 95% confidence interval [CI], −3.2 to −1.1)
Summary
Using the Japan Medical Data Center database, we identified patients aged ≤15 years visiting hospitals because of mild head injuries from January 1, 2008, to December 31, 2013. We excluded patients who were admitted to the hospital or received other medical examinations. Regression discontinuity analysis was used to compare proportions of patients undergoing head CT and having clinically important traumatic brain injury (ciTBI) overlooked before versus after the accident, adjusting for patient characteristics, secular trends, and hospital effect
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