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Reducing Ct-scan Utilization For Pediatric Minor Head Injury In The Emergency Department: A Quality Improvement Initiative
Rajan Arora1, Yagnaram Ravichandran1, Usha Sethuraman1, Ahmad Farooqi1, Emily White2, Kristin Watson1, Nancy Radovic1, Elena Sikaleski1, Elizabeth Yost1, Deborah Niedbala1
1Children's Hospital of Michigan, Detroit, MI;2University of Michigan, Ann Arbor, MI

Background (issue):The validated Pediatric Emergency Care Applied Research Network (PECARN) prediction rules are meant to aid clinicians in safely reducing unwarranted imaging in minor head injuries (MHI). Even so, CT utilization remains high, especially in intermediate risk MHI. The primary objective was to reduce CT utilization rates in the intermediate risk group (per PECARN) MHI patients by 20% from baseline value of ~19% by December 2018.
Methods: This project was conducted in a level 1 trauma pediatric ED. Children < 18 years evaluated for intermediate risk MHI from June 2016-Dec 2018 were included. Data were obtained from Arbor Metrix, an electronic data repository for the Michigan Emergency Department Improvement Collaborative (MEDIC). Key drivers in this Plan-Do-Study-Act model were provider education, decision support, shared decision making and performance evaluation. Primary outcome measure was reduction in CT utilization rates. Balancing measure included clinically important traumatic brain injury identified on revisit within 72 hr. but missed on index visit.
Findings: 1270 eligible patients were analyzed. 56% (711) were in the post-intervention period (Jul 2017-Dec 2018). We demonstrated a 25% reduction in CT utilization [From baseline 18.8% (105/559) to 14% (100/711);p-value < 0.001] and it corresponded with our interventions (Figure 1). There were no revisits to our institution within 72 hr. with a missed serious head injury.
Conclusions (implications for practice): Our multifaceted QI initiative was both safe and effective in reducing our CT utilization rates in intermediate risk MHI.


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