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Utilization Patterns of CT-Scan for Minor Head Trauma in children - Choosing Wisely
Yagnaram Ravichandran, MD1; Kristin Watson, RN, BSN2; Deborah Neidbala, RN, MSN2; Nancy Radovic, RN2; Elena Sikaleski, BS3; Rajan Arora, MD2
1Childrens Hospital of Michigan Detroit Medical Center, Grosse Pointe Park, MI; 2Childrens Hospital of Michigan, Detroit, MI; 3Detroit Medical Center - Children's Hospital of Michigan, Detroit, MI

Background: In the United States significant practice variations exist in the utilization of CT scans in the ED for minor head injury (MHI) in children. Reported rates vary between 20% to 40%.1 Unnecessary CT scans expose children to radiation and impact healthcare costs. PECARN rules are useful in guiding clinicians with the CT decision making process.2 Our objective is to describe utilization and measure appropriateness of CT scans in children with MHI at a tertiary care level I trauma center.

Methods: Retrospective chart review from June 2016 to February 2018. Data obtained from the Michigan Emergency Department Improvement Collaborative (MEDIC) registry. Inclusion Criteria - All children 24 hrs; Penetrating trauma; Non-accidental trauma; focal neurological deficits; coagulopathies; History of brain mass/shunt; Trauma code activation.

Results: Table 1. Demographics and CT utilization rates. N=4815 (%)

Conclusions: Our low CT usage rates for minor head injury patients are indicative of adherence to PECARN guidelines by medical staff. Clinical prediction rules help standardize care and reduce variability based on provider training level. Shared decision making with radiologists may further aid in judicious use of CT scans.


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