Miescier Michael J, Dudley Nanette C, Kadish Howard A, Mundorff Michael B, Corneli Howard M
From the *Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Utah School of Medicine; and †Systems Improvement Department, Intermountain Healthcare, Salt Lake City, UT.
Pediatr Emerg Care. 2017 Mar;33(3):156-160. doi: 10.1097/PEC.0000000000000500.
Recent research has shown significant variation in rates of computed tomography (CT) use among pediatric hospital emergency departments (ED) for evaluation of head injured children. We examined the rates of CT use by individual ED attending physicians for evaluation of head injured children in a pediatric hospital ED.
We used an administrative database to identify children younger than 18 years evaluated for head injury from January 2011 through March 2013 at our children's hospital ED, staffed by pediatric emergency medicine (PEM) fellowship trained physicians and pediatricians. We excluded encounters with trauma team activation or previous head CT performed elsewhere. We excluded physicians whose patient volume was less than 1 standard deviation below the group mean.
After exclusions, we evaluated 5340 encounters for head injury by 27 ED attending physicians. For individual physicians, CT rates ranged from 12.4% to 37.3%, with a mean group rate of 28.4%. Individual PEM physician CT rates ranged from 18.9% to 37.3%, versus 12.4% to 31.8% for pediatricians. Of the 1518 encounters in which CT was done, 128 (8.4%) had a traumatic brain injury on CT, and 125 (8.2%) had a simple skull fracture without traumatic brain injury on CT. Patient factors associated with CT use included age younger than 2 years, higher triage acuity, arrival time of 10:00 PM to 6:00 AM, hospital admission, and evaluation by a PEM physician.
Physicians at our pediatric hospital ED varied in the use of CT for the evaluation of head-injured children.
近期研究表明，儿科医院急诊科（ED）在使用计算机断层扫描（CT）评估头部受伤儿童方面，使用率存在显著差异。我们研究了儿科医院急诊科中，每位急诊科主治医生使用CT评估头部受伤儿童的比率。
我们使用一个管理数据库，确定2011年1月至2013年3月期间在我院儿童医院急诊科接受头部受伤评估的18岁以下儿童，该急诊科由经过儿科急诊医学（PEM）专科培训的医生和儿科医生 staffed （此处原英文单词有误，推测可能是staffed，意为“配备人员”）。我们排除了有创伤团队激活情况或之前在其他地方进行过头部CT检查的病例。我们排除了患者量低于组均值1个标准差的医生。
排除后，我们评估了27位急诊科主治医生对5340例头部受伤病例的诊治情况。对于个体医生而言，CT使用率在12.4%至37.3%之间，组平均使用率为28.4%。PEM专科医生个体的CT使用率在18.9%至37.3%之间，而儿科医生的使用率在12.4%至31.8%之间。在进行CT检查的1518例病例中，128例（8.4%）CT显示有创伤性脑损伤，125例（8.2%）CT显示有单纯颅骨骨折但无创伤性脑损伤。与CT使用相关的患者因素包括年龄小于2岁、分诊 acuity （此处原英文单词有误，推测可能是acuity，意为“敏锐度、严重程度”）较高、晚上10点至早上6点到达、住院以及由PEM专科医生进行评估。
我院儿科医院急诊科医生在使用CT评估头部受伤儿童方面存在差异。
