Blackwell Charles D, Gorelick Marc, Holmes James F, Bandyopadhyay Subhankar, Kuppermann Nathan
Department of Emergency Medicine, Children's Hospitals and Clinics of Minnesota, Minneapolis, MN 55404, USA.
Ann Emerg Med. 2007 Mar;49(3):320-4. doi: 10.1016/j.annemergmed.2006.09.025. Epub 2006 Dec 4.
Head trauma is common in children. In the absence of evidence-based recommendations, variations exist in the initial emergency department (ED) evaluation and treatment of children with head trauma. We sought to describe the use of computed tomography (CT) over time in the treatment of children with acute closed head trauma in US EDs.
This was a cross-sectional analysis of data from the National Hospital Ambulatory Care Survey database from 1995 to 2003. We identified patients aged 0 to 18 years, with head trauma by chief complaint or discharge diagnosis. We collected the following data: chief complaint, patient demographics, patient disposition, discharge diagnosis, and use of CT. Frequency and characteristics of the use of CT scan for evaluation of children with head trauma. We used descriptive statistics with appropriate weighting to account for the survey methodology. We determined the frequency and the characteristics of the use of CT scans for evaluation of children with head trauma. We used descriptive statistics with appropriate weighting to account for the survey methodology.
We identified 2,747 patient encounters, representing 10,536,717 pediatric head trauma visits during the 9-year period. The use of CT increased from 12.8% to 22.4% from 1995 to 2003, with a peak of 28.6% in 2000. CT was used more frequently in the older age groups: 13% (<1 year), 11% (1 to 4 years), 20% (5 to 9 years), and 32% (10 to 18 years). CT was also used more frequently in general EDs (22%) than in pediatric-specific EDs (13%). There were no differences in CT use between teaching and nonteaching facilities (21% in each). Overall, 6.4% of children were either admitted to the hospital or transferred, and this rate remained stable over time.
The use of CT has increased substantially in the evaluation of children with head trauma from 1995 to 2003. Further study is needed to identify objective criteria for cranial CT in head-injured children and to evaluate the impact of increased CT use on patient outcomes.
儿童头部创伤很常见。在缺乏循证医学建议的情况下，儿童头部创伤的初始急诊科（ED）评估和治疗存在差异。我们试图描述美国急诊科对急性闭合性头部创伤儿童进行计算机断层扫描（CT）检查的使用情况随时间的变化。
这是一项对1995年至2003年国家医院门诊护理调查数据库数据的横断面分析。我们确定年龄在0至18岁、因主诉或出院诊断为头部创伤的患者。我们收集了以下数据：主诉、患者人口统计学信息、患者处置情况、出院诊断以及CT检查的使用情况。用于评估头部创伤儿童的CT扫描的使用频率和特征。我们使用带有适当权重的描述性统计方法来考虑调查方法。我们确定了用于评估头部创伤儿童的CT扫描的使用频率和特征。我们使用带有适当权重的描述性统计方法来考虑调查方法。
我们确定了2747例患者就诊病例，代表了9年期间10536717次儿科头部创伤就诊。从1995年到2003年，CT检查的使用率从12.8%上升到22.4%，2000年达到峰值28.6%。年龄较大的儿童组CT检查使用更频繁：1岁以下（13%）、1至4岁（11%）、5至9岁（20%）和10至18岁（32%）。综合急诊科（22%）使用CT检查也比儿科专科医院急诊科（13%）更频繁。教学医院和非教学医院在CT检查使用方面没有差异（各为21%）。总体而言，6.4%的儿童被收治入院或转诊，且这一比例随时间保持稳定。
从1995年到2003年，CT检查在头部创伤儿童评估中的使用显著增加。需要进一步研究以确定头部受伤儿童进行头颅CT检查的客观标准，并评估增加CT检查使用对患者预后的影响。
