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Head CT in Kids with Minor Head Injury Down After Quality-Improvement Effort


NEW YORK (Reuters Health) - Following a quality-improvement effort at the Boston Children's Hospital emergency department, the number of head CT scans for children with blunt head trauma has dropped without missing any significant injuries, researchers say.

"A combination of an evidence-based guideline and individual provider feedback was associated with a reduction in cranial CT rates," Dr. Lise Nigrovic from Boston Children's told Reuters Health by email. "Clinicians successfully identified all children with head injuries requiring acute intervention."

The evidence-based guideline was based on the PECARN TBI clinical prediction rules, Dr. Nigrovic and her colleagues explain in a report in Pediatrics, online June 22. Immediate CT is recommended for children with either a single high-risk or at least three of the other PECARN TBI predictors.

A period of observation before deciding on CT is recommended for children with one or two predictors, and no CT is recommended for children without PECARN TBI predictors.

The goal of individual provider feedback was to improve awareness, acceptance, adoption and adherence to head trauma guideline recommendations. Each fall, ED providers receive a confidential report of annual cranial CT rates for ED patients with minor blunt head trauma for the previous year. Providers also get information on median overall division CT rate for the previous year, with the goal of reducing variability between providers while further decreasing overall CT rate.

Dr. Nigrovic's team analyzed more than 6,800 ED visits for minor head injuries, of which 62% occurred after implementation of the initiative.

From a baseline head CT rate of 21%, they observed a significant reduction of 6 percentage points in cranial CT rate after initial guideline implementation, and an additional drop of 6 percentage points after initiation of individual provider feedback, the researchers report.

"No children discharged from the ED required admission within 72 hours of initial evaluation," they note.

"Importantly," they add, the decline in the head CT rate has been sustained for two years so far after implementation, "which supports the sustainability of the QI (quality improvement) interventions."

"We believe that these changes are generalizable," Dr. Nigrovic told Reuters Health. "In fact, we have described our QI intervention in detail to help with adoption by other centers."

The study had no commercial funding and the authors have disclosed no potential conflicts of interest.

Reuters Health

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