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Variation in CT use for paediatric head injuries across different types of emergency departments in Australia and New Zealand
  1. Catherine L Wilson1,2,
  2. Emma J Tavender1,3,
  3. Natalie T Phillips4,5,
  4. Stephen JC Hearps6,
  5. Kelly Foster2,7,
  6. Sharon L O'Brien8,9,
  7. Meredith L Borland10,11,
  8. Gina O Watkins2,12,
  9. Lorna McLeod13,
  10. Mark Putland14,
  11. Stephen Priestley15,
  12. Christine Brabyn16,
  13. Dustin W Ballard17,
  14. Simon Craig18,19,
  15. Stuart R Dalziel20,21,
  16. Ed Oakley3,22,
  17. Franz E Babl1,22,23
  18. Paediatric Research in Emergency Department's International Collaborative
    1. 1Emergency Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia
    2. 2Paediatric Research in Emergency Departments International Collaborative, Murdoch Children's Research Institute, Parkville, Victoria, Australia
    3. 3Paediatrics, University of Melbourne, Parkville, Victoria, Australia
    4. 4Emergency Department, Queensland Children’s Hospital, South Brisbane, Queensland, Australia
    5. 5Child Health Research Centre, University of Queensland, Brisbane, Queensland, Australia
    6. 6Clinical Sciences, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
    7. 7School of Nursing and Midwifery, University of Southern Queensland, Ipswich, Queensland, Australia
    8. 8Emergency, Perth Children’s Hospital, Nedlands, Western Australia, Australia
    9. 9School of Nursing, Midwifery & Paramedicine, Curtin University, Perth, Western Australia, Australia
    10. 10Emergency Department, Perth Children’s Hospital, Perth, Western Australia, Australia
    11. 11Divisions of Paediatrics and Emergency Medicine, School of Medicine, The University of Western Australia, Perth, Western Australia, Australia
    12. 12Emergency Department, Sutherland Hospital, Caringbah, New South Wales, Australia
    13. 13Emergency Department, Coffs Harbour Base Hospital, Coffs Harbour, New South Wales, Australia
    14. 14Emergency Department, Bendigo Health—Bendigo Hospital Campus, Bendigo, Victoria, Australia
    15. 15Emergency Department, Sunshine Coast University Hospital, Sunshine Coast, Queensland, Australia
    16. 16Emergency Department, Waikato District Health Board, Hamilton, New Zealand
    17. 17Northern California Division of Research, Kaiser Permanente, Oakland, California, USA
    18. 18Emergency Department, Monash Medical Centre Clayton, Clayton, Victoria, Australia
    19. 19Department of Paediatrics, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
    20. 20Emergency Department, Starship Children’s Health, Auckland, New Zealand
    21. 21Departments of Surgery and Paediatrics: Child and Youth Health, The University of Auckland, Auckland, Auckland, New Zealand
    22. 22Emergency Department, Royal Children’s Hospital, Parkville, Victoria, Australia
    23. 23Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
    1. Correspondence to Dr Franz E Babl, Emergency Research, Murdoch Childrens Research Institute, Parkville, VIC 3052, Australia; franz.babl{at}rch.org.au

    Abstract

    Objectives CT 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.

    Methods Multicentre 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.

    Results There 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%).

    Conclusions In 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.

    • emergency departments
    • guidelines
    • imaging, CT/MRI
    • paediatrics, paediatric emergency medicine
    • trauma, head
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    Footnotes

    • Handling editor Katie Walker

    • Twitter @KelFoster3, @PREDICT_network

    • Correction notice This paper has been updated since first published to amend author names '

      Natalie T Phillips, Stephen JC Hearps, Sharon L O’Brien, Meredith L Borland, Stuart R Dalziel'.

    • Collaborators Paediatric Research in Emergency Department's International Collaborative: Jamie Lew, Stephen Teo, Amie Beattie, Mary McCaskill, Arjun Rao, Jo Cole, Adam Michael, Shane George, Alex King, Corey Cassidy, Ben Lawton, Frances Kinnear, Amit Kochar, Lalith Gamage, Peter Archer, Ashes Mukherjee, Russell Young, Hugh Mitenko.

    • Contributors FEB: conceived the study, obtained grant funding, designed the study, provided overall supervision, interpreted the data, gave final approval to be published and agreed to be accountable for all aspects of the work. CLW: designed the study, provided supervision, interpreted the data, wrote the first draft, gave final approval to be published and agreed to be accountable for all aspects of the work. EJT, EO and SD: designed the study, obtained the data, provided supervision, interpreted the data, drafted or revised it critically, gave final approval to be published and agreed to be accountable for all aspects of the work. NP, KF, SO, MB, GOOW, LM, MP, SP, CB and SC: obtained the data, provided supervision, interpreted the data, revised it critically, gave final approval to be published and agreed to be accountable for all aspects of the work. DWB: contributed to the interpretation of the data, revised the paper critically, gave final approval to be published and agreed to be accountable for all aspects of the work. SC: performed the analysis of the data, contributed to the interpretation of the data, revised the paper critically, gave final approval to be published and agreed to be accountable for all aspects of the work. Collaborators: were principal investigators at the sites and contributed their site’s data.

    • Funding This study was funded by Angior Family Foundation; Emergency Medicine Foundation (EMPJ-375R27-2017-PHILLIPS) Queensland; the National Health and Medical Research Council Centre of Research Excellence grant for Paediatric Emergency Medicine (GNT1058560), Australia and by the Victorian Government's Operational Infrastructure Support Program.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement No data are publicly available. Ethics committee approval was not provided for sharing of site data.

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