Assessment of Pediatric Neurotrauma Imaging Appropriateness at a Level I Pediatric Trauma Center.
Publication/Presentation Date
7-1-2016
Abstract
PURPOSE: The aim of this study was to assess the prevalence of appropriate neuroimaging on the basis of the ACR Appropriateness Criteria among pediatric patients presenting after head trauma to a level I emergency department.
METHODS: A retrospective emergency department record review was performed for patients"head trauma" between January 2013 and December 2014. Clinical history and symptoms were compared with the ACR Appropriateness Criteria; the indication was deemed appropriate for ratings of ≥7. Patients were analyzed by age, gender, presentation, imaging obtained, follow-up, treatment, and outcomes.
RESULTS: Among 207 patients, 120 (58%) were imaged with CT and 107 (52%) with MRI; 20 patients underwent both CT and MRI. One hundred eighty-seven patients (90.3%) were appropriately imaged, with 90.0% of CT studies (108 of 120) deemed appropriate and 91.6% of MRI studies (98 of 107) deemed appropriate. Younger patients were more likely to be inappropriately imaged with CT or MRI than older patients (P = .02 and P < .01, respectively). Patients undergoing CT were older (mean age 9.9 ± 5.8 years) and more likely to be male (85.2%) than those undergoing MRI (5.6 ± 5.6 years and 55.1%, respectively) (P < .01 and P < .001, respectively). The diagnostic yield of positive imaging findings for intracranial trauma was significantly lower in the MRI group (P < .01), and patients undergoing MRI were significantly more likely to return to baseline with conservative management (P < .01).
CONCLUSIONS: Most pediatric patients undergoing neuroimaging for head trauma did so appropriately per ACR guidelines and had symptom resolution with conservative management. The minority not imaged appropriately represent a target for quality improvement efforts.
Volume
13
Issue
7
First Page
788
Last Page
793
ISSN
1558-349X
Published In/Presented At
Rao, S., Rao, S., Rincon, S., Caruso, P., Ptak, T., Raja, A. S., Prabhakar, A. M., & Harvey, H. B. (2016). Assessment of Pediatric Neurotrauma Imaging Appropriateness at a Level I Pediatric Trauma Center. Journal of the American College of Radiology : JACR, 13(7), 788–793. https://doi.org/10.1016/j.jacr.2016.02.022
Disciplines
Diagnosis | Medicine and Health Sciences | Other Analytical, Diagnostic and Therapeutic Techniques and Equipment | Radiology
PubMedID
27084071
Department(s)
Department of Radiology and Diagnostic Medical Imaging
Document Type
Article
