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Probability of Head CT Use in Non-Trauma Centers Compared to Pediatric Trauma Centers
Laura D. Cassidy, MS, PhD, Meredith Halling, MS and Allison Ertl, MS, Medical College of Wisconsin, Milwaukee WI; Schuyler Schmidt, MS, Ohio Department of Health, Columbus OH; Jonathan I. Groner, MD, Nationwide Children's Hospital, Columbus OH

Abstract: Introduction: Head CT is a common diagnostic tool for diagnosing pediatric head injuries but it is expensive and exposes children to ionizing radiation. Methods: State registry data were analyzed for 3,658 patients <16 years old with a head injury identified as the most severe injury (using AIS) and who arrived from the injury scene to the first hospital of care over a six-year period. Deaths in the ED were excluded (n=31). Head CT use was compared between pediatric trauma centers (PTC) adult trauma centers levels1-3 (ATC 1-3) and 138 non-verified trauma centers (NTC) using logistic regression and controlling for severity with Glasgow Coma Scale (GCS). Results: 36% of children were first seen at a NTC and 35% were first seen at a PTC. NTC’s and ATC 3’s had significantly higher adjusted odds of performing a head CT than PTCs (NTC OR=8.0, 95%CI 6.5-9.7, ATC3 OR=1.5, 95%CI 1.1-2.0). 98.7% of 1,332 mildly head injured children seen at NTCs were transferred to a higher level of care. The Figure shows that the probability of obtaining a head CT is highest at the initial hospital for all GCS’s for patients who are subsequently transferred to a higher level of care. Conclusions: NTCs have the highest head CT scan rate even though nearly all patients are transferred out. Further investigation will determine the impact of this variability on patient outcomes.

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Objective: Discuss the potential overuse of head CT for pediatric patients in unverified trauma centers.

Objective Content: At the end of this presentation the learner will be aware of the high use of CT scanning for mild head injury at sites that are not verified trauma centers. They will learn to interpret risk adjusted data on head injuries.


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