Reducing Head CT Use for Children With Head Injuries in a Community Emergency Department.
Publication Title
Pediatrics
Document Type
Article
Publication Date
4-1-2017
Keywords
Adolescent; Child; Child, Preschool; Craniocerebral Trauma; Decision Support Techniques; Emergency Service, Hospital; Female; Head; Hospitals, Community; Humans; Male; Quality Improvement; Retrospective Studies; Tomography, X-Ray Computed
Abstract
BACKGROUND AND OBJECTIVE: Clinical decision rules have reduced use of computed tomography (CT) to evaluate minor pediatric head injury in pediatric emergency departments (EDs). CT use remains high in community EDs, where the majority of children seek medical care. We sought to reduce the rate of CT scans used to evaluate pediatric head injury from 29% to 20% in a community ED.
METHODS: We evaluated a quality improvement (QI) project in a community ED aimed at decreasing the use of head CT scans in children by implementing a validated head trauma prediction rule for traumatic brain injury. A multidisciplinary team identified key drivers of CT use and implemented decision aids to improve the use of prediction rules. The team identified and mitigated barriers. An affiliated children's hospital offered Maintenance of Certification credit and QI coaching to participants. We used statistical process control charts to evaluate the effect of the intervention on monthly CT scan rates and performed a Wald test of equivalence to compare preintervention and postintervention CT scan proportions.
RESULTS: The baseline period (February 2013-July 2014) included 695 patients with a CT scan rate of 29.2% (95% confidence interval, 25.8%-32.6%). The postintervention period (August 2014-October 2015) included 651 patients with a CT scan rate of 17.4% (95% confidence interval, 14.5%-20.2%,
CONCLUSIONS: We demonstrate that a Maintenance of Certification QI project sponsored by a children's hospital can facilitate evidence-based pediatric care and decrease the rate of unnecessary CT use in a community setting.
Area of Special Interest
Women & Children
Specialty/Research Institute
Emergency Medicine
Specialty/Research Institute
Diagnostic Imaging
Specialty/Research Institute
Pediatrics
