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Cost-Saving Potential of Improved Patient Selection for Neuroimaging Following Pediatric Blunt Head Trauma
Simone Langness, MD1, Erin Ward, MD1, Jonathan Halbach, DO2, Stephen Bickler, MD3, Katherine Davenport, MD3, Timothy Fairbanks, MD3. 1UC San Diego, San Diego, CA, USA, 2Naval Medical Center, San Diego, CA, USA, 3Rady Children's Hospital, San Diego, CA, USA.

Pediatric blunt head trauma (BHT) is responsible for >500,000 ED visits annually and is estimated to cost $2.6 billion per year. Neuroimaging is a major contributor to the costs of BHT evaluation. We have previously demonstrated that: 1) a negative D-Dimer is highly predictive of the absence of injury on head CT and 2) incorporating D-Dimer into current BHT screening algorithms could avoid 20-45% of unnecessary head CTs. We aimed to determine the cost saving potential of utilizing D-Dimer in the initial evaluation of pediatric BHT. Billing data was obtained from all patients presenting with BHT to our Level I Pediatric Trauma Center from 2011-2013 who underwent evaluation with both CT head and serum D-Dimer through the Pediatric Health Information System (PHIS) database. Of the 553 patients evaluated in our series, 362 (65.4%) had no radiologic evidence of injury. The average total billing charges for these patients was $35,192 and imaging accounted for 16% of all charges ($4,888). Using a D-dimer value of <750 pg/µL as a negative cut-off for not pursuing a head CT would have avoided 197 (54%) head CTs without missing a clinically-important traumatic brain injury. The cost-saving potential from imaging alone would be >$800,000. The cost-savings potential if ED observation was performed in these patients over hospital admission would be >$6.5 million. Incorporating D-Dimer into current imaging screening algorithms following blunt head trauma not only has the advantage of better patient selection, but also has significant cost-savings potential.


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