From the Department of Pediatric Emergency and Critical Care Medicine, Tokyo Metropolitan Children's Medical Center.
Department of Human Resources Development, Bureau of International Health Cooperation, National Center for Global Health and Medicine, Tokyo, Japan.
Pediatr Emerg Care. 2020 Oct;36(10):e564-e567. doi: 10.1097/PEC.0000000000001487.
The aim of this study was to evaluate the effect of an observation unit (OU) in an emergency department on reducing unnecessary use of computed tomography (CT) for minor blunt head trauma.
This study was a retrospective before-and-after study of pediatric patients 18 years or younger with minor blunt head trauma. Patients with a Glasgow Coma Scale score of 14 or 15 who presented to the emergency department were included in the analysis. The rates of head CT use in the period before and after the institution of the OU were compared.
In total, 4706 patients were analyzed (2344 from the period before and 2362 from period after OU institution). The median age of the patients was 3 years, and 64% were male in each period. The rates of CT use were 5.7% (95% confidence interval [CI], 4.8%-6.7%) in the period before and 4.0% (95% CI, 3.3%-4.9%) in the period after OU institution (P = 0.01). The relative risk reduction was 0.70 (95% CI, 0.54-0.91).
The rate of CT use decreased by 30% as a result of OU institution. The OU was an effective means of avoiding an unnecessary head CT for pediatric minor head injuries.
本研究旨在评估急诊科观察单元（OU）对减少轻微钝性头部创伤不必要的计算机断层扫描（CT）使用的效果。
这是一项回顾性前后对照研究，纳入了 18 岁或以下患有轻微钝性头部创伤的儿科患者。格拉斯哥昏迷量表评分 14 或 15 分的患者在急诊科就诊时被纳入分析。比较 OU 建立前后头部 CT 使用率。
共分析了 4706 例患者（OU 建立前为 2344 例，建立后为 2362 例）。患者的中位年龄为 3 岁，每个时期男性比例均为 64%。OU 建立前 CT 使用率为 5.7%（95%置信区间，4.8%-6.7%），OU 建立后为 4.0%（95%置信区间，3.3%-4.9%）（P = 0.01）。相对风险降低了 0.70（95%置信区间，0.54-0.91）。
由于 OU 的建立，CT 使用率降低了 30%。OU 是避免儿科轻微头部损伤不必要头部 CT 的有效手段。
