Impact of the updated NICE guidance on CT head scans performed in the emergency department for head injury

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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Outcome Prediction in Patients of Traumatic Brain Injury Based on Midline Shift on CT Scan of Brain

Indian Journal of Neurosurgery ◽

10.1055/s-0040-1716990 ◽

2021 ◽

Author(s):

Shrikant Govindrao Palekar ◽

Manish Jaiswal ◽

Mandar Patil ◽

Vijay Malpathak

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Head Injury ◽

Ct Scan ◽

Treatment Protocol ◽

Emergency Setting ◽

Midline Shift ◽

Ct Head ◽

Clinical Tools ◽

Gcs Score

Abstract Background Clinicians treating patients with head injury often take decisions based on their assessment of prognosis. Assessment of prognosis could help communication with a patient and the family. One of the most widely used clinical tools for such prediction is the Glasgow coma scale (GCS); however, the tool has a limitation with regard to its use in patients who are under sedation, are intubated, or under the influence of alcohol or psychoactive drugs. CT scan findings such as status of basal cistern, midline shift, associated traumatic subarachnoid hemorrhage (SAH), and intraventricular hemorrhage are useful indicators in predicting outcome and also considered as valid options for prognostication of the patients with traumatic brain injury (TBI), especially in emergency setting. Materials and Methods 108 patients of head injury were assessed at admission with clinical examination, history, and CT scan of brain. CT findings were classified according to type of lesion and midline shift correlated to GCS score at admission. All the subjects in this study were managed with an identical treatment protocol. Outcome of these patients were assessed on GCS score at discharge. Result Among patients with severe GCS, 51% had midline shift. The degree of midline shift in CT head was a statistically significant determinant of outcome (p = 0.023). Seventeen out of 48 patients (35.4%) with midline shift had poor outcome as compared with 8 out of 60 patients (13.3%) with no midline shift. Conclusion In patients with TBI, the degree of midline shift on CT scan was significantly related to the severity of head injury and resulted in poor clinical outcome.

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Emergency Department Visits From 2014 to 2018 for Head Injuries in Youth Non-Tackle Football Compared With Other Sports

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120975402 ◽

2021 ◽

Vol 9 (1) ◽

pp. 232596712097540

Author(s):

Jessica M. Zendler ◽

Ron Jadischke ◽

Jared Frantz ◽

Steve Hall ◽

Grant C. Goulet

Keyword(s):

United States ◽

Emergency Department ◽

Head Injury ◽

Head Injuries ◽

The United States ◽

Emergency Department Visits ◽

Head Region ◽

Cerebral Contusion ◽

Common Diagnosis ◽

Tackle Football

Background: Non-tackle football (ie, flag, touch, 7v7) is purported to be a lower-risk alternative to tackle football, particularly in terms of head injuries. However, data on head injuries in non-tackle football are sparse, particularly among youth participants. Purpose: To describe the epidemiology of emergency department visits for head injuries due to non-tackle football among youth players in the United States and compare the data with basketball, soccer, and tackle football. Study Design: Descriptive epidemiology study. Methods: Injury data from 2014 to 2018 were obtained from the National Electronic Injury Surveillance System database. Injury reports coded for patients aged 6 to 18 years and associated with basketball, football, or soccer were extracted. Data were filtered to include only injuries to the head region, specifically, the head, ear, eyeball, mouth, or face. Football injuries were manually assigned to “non-tackle” or “tackle” based on the injury narratives. Sports & Fitness Industry Association data were used to estimate annual sport participation and calculate annual injury rates per 100,000 participant-years. Results: A total of 26,770 incident reports from 2014 to 2018 were analyzed. For head region injuries in non-tackle football, the head was the most commonly injured body part, followed by the face; the most common diagnosis was a laceration, followed by concussion and internal injury (defined as an unspecified head injury or internal head injury [eg, subdural hematoma or cerebral contusion]). The most common contacting object was another player. The projected national rate of head region injuries was lowest for non-tackle football across the 4 sports. In particular, the projected rate of injuries to the head for non-tackle football (78.0 per 100,000 participant-years) was less than one-fourth the rates for basketball (323.5 per 100,000 participant-years) and soccer (318.2 per 100,000 participant-years) and less than one-tenth the rate for tackle football (1478.6 per 100,000 participant-years). Conclusion: Among youth in the United States aged 6 to 18 years who were treated in the emergency department for injuries related to playing non-tackle football, the most common diagnosis for injuries to the head region was a laceration, followed by a concussion. Head region injuries associated with non-tackle football occurred at a notably lower rate than basketball, soccer, or tackle football.

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