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Selecting children for head CT following head injury
  1. A Kemp1,
  2. E Nickerson1,
  3. L Trefan1,
  4. R Houston2,
  5. P Hyde3,
  6. G Pearson4,
  7. R Edwards5,
  8. RC Parslow6,
  9. I Maconochie7
  1. 1College of Biomedical and Life Sciences, School of Medicine, Cardiff University, Cardiff, Wales, UK
  2. 2Research fellow CMACE (at the time of the project). Placements Manager at Kids Company, London, UK
  3. 3Paediatric Intensive Care Unit, Southampton Children's Hospital, Southampton, UK
  4. 4Consultant in Intensive Care, Birmingham Children's Hospital, Birmingham, UK
  5. 5Department of Neurosurgery, Bristol Hospital for Children, Bristol, UK
  6. 6Senior Lecturer in Epidemiology, Leeds Institute of Cardiovascular and Metabolic Medicine, School of Medicine, University of Leeds, Leeds, UK
  7. 7Paediatric Emergency Medicine Consultant, Imperial College NHS Healthcare Trust, London, UK
  1. Correspondence to Professor Alison Kemp, College of Biomedical and Life Sciences, School of Medicine, Cardiff University, Cardiff, CF14 4XY, UK; KempAM{at}cardiff.ac.uk

Abstract

Objective Indicators for head CT scan defined by the 2007 National Institute for Health and Care Excellence (NICE) guidelines were analysed to identify CT uptake, influential variables and yield.

Design Cross-sectional study.

Setting Hospital inpatient units: England, Wales, Northern Ireland and the Channel Islands.

Patients Children (<15 years) admitted to hospital for more than 4 h following a head injury (September 2009 to February 2010).

Interventions CT scan.

Main outcome measures Number of children who had CT, extent to which NICE guidelines were followed and diagnostic yield.

Results Data on 5700 children were returned by 90% of eligible hospitals, 84% of whom were admitted to a general hospital. CT scans were performed on 30.4% of children (1734), with a higher diagnostic yield in infants (56.5% (144/255)) than children aged 1 to 14 years (26.5% (391/1476)). Overall, only 40.4% (984 of 2437 children) fulfilling at least one of the four NICE criteria for CT actually underwent one. These children were much less likely to receive CT if admitted to a general hospital than to a specialist centre (OR 0.52 (95% CI 0.45 to 0.59)); there was considerable variation between healthcare regions. When indicated, children >3 years were much more likely to have CT than those <3 years (OR 2.35 (95% CI 2.08 to 2.65)).

Conclusion Compliance with guidelines and diagnostic yield was variable across age groups, the type of hospital and region where children were admitted. With this pattern of clinical practice the risks of both missing intracranial injury and overuse of CT are considerable.

  • Accident & Emergency
  • Imaging

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

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