Abstract
IntroductionQuestions surround the appropriate emergency department (ED) disposition of children who have sustained blunt head trauma (BHT). Our objective was to identify physician disposition preferences of children with blunt head trauma (BHT) and varying computed tomography (CT) findings.Methods:We surveyed pediatric and general emergency physicians (EP), pediatric neurosurgeons (PNSurg), general neurosurgeons (GNSurg), pediatric surgeons (PSurg) and trauma surgeons regarding care of two hypothetical patients: Case 1: a 9-year-old who fell 10 feet and Case 2: an 11-month-old who fell 5 feet. We presented various CT findings and asked physicians about disposition preferences. We evaluated predictors of patient discharge using multivariable regression analysis adjusting for hospital and ED characteristics and clinician experience. Pediatric EPs served as the reference group.Results:Of 2,341 eligible surveyed, 715 (31%) responded. Most would discharge children with linear skull fractures (Case 1, 71%; Case 2, 62%). Neurosurgeons were more likely to discharge children with small subarachnoid hemorrhages (Case 1 PNSurg OR 6.87, 95% CI 3.60, 13.10; GNSurg OR 6.54, 95% CI 2.38, 17.98; Case 2 PNSurg OR 5.38, 95% CI 2.64, 10.99; GNSurg OR 6.07, 95% CI 2.08, 17.76). PSurg were least likely to discharge children with any CT finding, even linear skull fractures (Case 1 OR 0.14, 95% CI 0.08, 0.23; Case 2 OR 0.18, 95% CI 0.11, 0.30). Few respondents (<6%) would discharge children with small intraventricular, subdural, or epidural bleeds.Conclusion:Substantial variation exists between specialties in reported hospitalization practices of neurologically-normal children with BHT and traumatic CT findings.
Highlights
Questions surround the appropriate emergency department (ED) disposition of children who have sustained blunt head trauma (BHT)
pediatric surgeons (PSurg) were least likely to discharge children with any computed tomography (CT) finding, even linear skull fractures (Case 1 odds ratios (OR) 0.14, 95% confidence intervals (CI) 0.08, 0.23; Case 2 OR 0.18, 95% CI 0.11, 0.30)
Substantial variation exists between specialties in reported hospitalization practices of neurologically-normal children with BHT and traumatic CT findings. [West J Emerg Med. 2013;14(1):29-36.]
Summary
Questions surround the appropriate emergency department (ED) disposition of children who have sustained blunt head trauma (BHT). Our objective was to identify physician disposition preferences of children with blunt head trauma (BHT) and varying computed tomography (CT) findings. Traumatic brain injury (TBI) is a leading cause of death in children older than 1 year of age and a significant cause of morbidity. Between 2002 and 2006 the estimated annual number of TBIs in children less than 15 years of age in the U.S was approximately 511,000, including approximately 2,200 deaths, 35,000 hospitalizations, and 474,000 emergency department (ED) visits.[1] Cranial computed tomography (CT) is the diagnostic test of choice for evaluating children with blunt head trauma in the ED. Fewer than 10% of these CTs, are diagnostic of TBI.[2,3,4,5,6,7,8,9] the implications of small traumatic findings on CT are not clear.[10,11,12] CT should ideally be selectively used with the goal of identifying clinically-important findings
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