Delayed Presentations to Emergency Departments of Children With Head Injury: A PREDICT Study

ObjectivesCT of the brain (CTB) for paediatric head injury is used less frequently at tertiary paediatric emergency departments (EDs) in Australia and New Zealand than in North America. In preparation for release of a national head injury guideline and given the high variation in CTB use found in North America, we aimed to assess variation in CTB use for paediatric head injury across hospitals types.MethodsMulticentre retrospective review of presentations to tertiary, urban/suburban and regional/rural EDs in Australia and New Zealand in 2016. Children aged <16 years, with a primary ED diagnosis of head injury were included and data extracted from 100 eligible cases per site. Primary outcome was CTB use adjusted for severity (Glasgow Coma Scale) with 95% CIs; secondary outcomes included hospital length of stay and admission rate.ResultsThere were 3072 head injury presentations at 31 EDs: 9 tertiary (n=900), 11 urban/suburban (n=1072) and 11 regional/rural EDs (n=1100). The proportion of children with Glasgow Coma Score ≤13 was 1.3% in each type of hospital. Among all presentations, CTB was performed for 8.2% (95% CI 6.4 to 10.0) in tertiary hospitals, 6.6% (95% CI 5.1 to 8.1) in urban/suburban hospitals and 6.1% (95% CI 4.7 to 7.5) in regional/rural. Intragroup variation of CTB use ranged from 0% to 14%. The regional/rural hospitals admitted fewer patients (14.6%, 95% CI 12.6% to 16.9%, p<0.001) than tertiary and urban/suburban hospitals (28.1%, 95% CI 25.2% to 31.2%; 27.3%, 95% CI 24.7% to 30.1%).ConclusionsIn Australia and New Zealand, there was no difference in CTB use for paediatric patients with head injuries across tertiary, urban/suburban and regional/rural EDs with similar intragroup variation. This information can inform a binational head injury guideline.

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A prospective observational study to assess the diagnostic accuracy of clinical decision rules for children presenting to emergency departments after head injuries (protocol): the Australasian Paediatric Head Injury Rules Study (APHIRST)

BMC Pediatrics ◽

10.1186/1471-2431-14-148 ◽

2014 ◽

Vol 14 (1) ◽

Cited By ~ 43

Author(s):

Franz E Babl ◽

Mark D Lyttle ◽

Silvia Bressan ◽

Meredith Borland ◽

Natalie Phillips ◽

...

Keyword(s):

Head Injury ◽

Observational Study ◽

Diagnostic Accuracy ◽

Emergency Departments ◽

Prospective Observational Study ◽

Head Injuries ◽

Decision Rules ◽

Clinical Decision ◽

Clinical Decision Rules ◽

Paediatric Head Injury

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The Epidemiology of Pediatric Head Injury Treated Outside of Hospital Emergency Departments

Epidemiology ◽

10.1097/ede.0000000000000791 ◽

2018 ◽

Vol 29 (2) ◽

pp. 269-279 ◽

Cited By ~ 2

Author(s):

Cheryl K. Zogg ◽

R. Sterling Haring ◽

Likang Xu ◽

Joseph K. Canner ◽

Hatim A. AlSulaim ◽

...

Keyword(s):

Head Injury ◽

Emergency Departments ◽

Hospital Emergency ◽

Pediatric Head Injury ◽

Hospital Emergency Departments

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Is initial optic nerve sheath diameter prognostic of specific head injury in emergency departments?

Journal of the National Medical Association ◽

10.1016/j.jnma.2018.10.009 ◽

2019 ◽

Vol 111 (2) ◽

pp. 210-217

Author(s):

Bedriye Müge Sönmez ◽

Emirhan Temel ◽

Murat Doğan İşcanlı ◽

Fevzi Yılmaz ◽

Uğur Gülöksüz ◽

...

Keyword(s):

Optic Nerve ◽

Head Injury ◽

Emergency Departments ◽

Optic Nerve Sheath Diameter ◽

Optic Nerve Sheath ◽

Nerve Sheath

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Reduction of paediatric head CT utilisation at a rural general hospital emergency department

BMJ Quality & Safety ◽

10.1136/bmjqs-2019-010322 ◽

2020 ◽

Vol 29 (11) ◽

pp. 912-920

Author(s):

Jeffrey Paul Louie ◽

Joseph Alfano ◽

Thuy Nguyen-Tran ◽

Hai Nguyen-Tran ◽

Ryan Shanley ◽

...

Keyword(s):

Emergency Department ◽

Head Injury ◽

Rural Community ◽

Emergency Departments ◽

Control Charts ◽

Intervention Period ◽

Head Ct ◽

Pediatric Injury ◽

Ct Utilization ◽

Ct Head

BackgroundBlunt head injury is a common pediatric injury and often evaluated in general emergency departments. It estimated that 50% of children will undergo a head computed tomography (CT), often unnecessarily exposing the child to ionizing radiation. Pediatric academic centers have shown quality improvement (QI) measures can reduce head CT rates within their emergency departments. We aimed to reduce head CT utilization at a rural community emergency department.MethodsChildren presenting with a complaint of blunt head injury and were evaluated with or without a head CT. Head CT rate was the primary outcome. We developed a series of interventions and presented these to the general emergency department over the duration of the study. The pre and intervention data was analysed with control charts.ResultsThe preintervention and intervention groups consisted of 576 children: 237 patients with a median age of 8.0 years and 339 patients with a median age of 9.00 years (p=0.54), respectively. The preintervention HCT rate was 41.8% (95% CI 35.6% to 48.1%) and the postintervention rate was 27.7% (95% CI 23.3% to 32.7%), a decrease of 14.1% (95% CI 6.2% to 21.9%, p=0.0004). During the intervention period, there was a decrease in HCT rate of one per month (OR 0.96, 95% CI 0.92 to 1.00, p=0.07). The initial series of interventions demonstrated an incremental decrease in HCT rates corresponding with a special cause variation.ConclusionThe series of interventions dispersed over the intervention period was an effective methodology and successfully reduced HCT utilisation among children with blunt head injury at a rural community emergency department.

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Golf Related Head Injuries in Children: The Little Tigers

Scottish Medical Journal ◽

10.1177/003693309804300504 ◽

1998 ◽

Vol 43 (5) ◽

pp. 139-140 ◽

Cited By ~ 9

Author(s):

A.C. McGuffie ◽

M.O. Fitzpatrick ◽

D. Hall

Keyword(s):

Emergency Department ◽

Head Injury ◽

Emergency Departments ◽

Head Injuries ◽

Western Society ◽

Accident And Emergency ◽

Head Injured ◽

Accident And Emergency Department ◽

Injured Patients

Head injury is a major cause of morbidity in Western society and sport related incidents account for approximately 11% of all head injured patients attending Accident and Emergency Departments. 1 Golf was shown to be one of the sports most commonly associated with head injury requiring referral to a regional neurosurgical centre.2 Previous studies have demonstrated that it is predominantly children who sustain golf related head injuries which present either to an accident and emergency department3 or a regional neurosurgical centre.2 This study examines the number and pattern of golf related head injuries in children presenting to an accident and emergency department or requiring admission to the regional neurosurgical centre, over a three month period.

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