Pediatric head trauma: decision support safely cuts CT use

  • Ballard DW & al.
  • Ann Emerg Med
  • 22 Dec 2018

  • curated by Jenny Blair, MD
  • Clinical Essentials
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Takeaway

  • For children with head trauma presenting to the emergency department (ED), clinicians in this study ordered fewer head CTs if provided with electronic clinical decision support (CDS).

Why this matters

  • Decisions about head CTs for children with 1 “intermediate” Pediatric Emergency Care Applied Research Network (PECARN) risk factor for clinically important brain injury can be especially difficult.

Key results

  • Proportion undergoing head CTs after vs before CDS: 21.6% vs 24.2%.
    • aOR: 0.73 (95% CI, 0.60-0.88).
  • No change at control sites.
  • Among 5804 patients with non-negligible risk, 37/37 important injuries were found before intervention and 32/33 after.
  • Child with missed injury did not require intubation or neurosurgery.

Study design

  • Secondary analysis of nonrandomized multicenter before-and-after TBI-KT trial.
  • Participants were children with minor blunt head trauma and 1 PECARN intermediate-risk factor, with known risk for clinically important injury (n=3859).
  • At intervention sites, clinicians received CDS in electronic health record (EHR; n=1702) after baseline period without support (n=1711); control sites received no CDS (n=446).
  • CDS included risk estimates, recommendations.
  • Outcome: proportion of patients undergoing head CT in ED.
  • Funding: American Recovery and Reinvestment Act.

Limitations

  • Use of CDS tool was optional.
  • Potential unmeasured confounders.

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