Gerber Noam, Sookraj Kelley, Munnangi Swapna, Angus L D George, Lamba Vineet, Kumar Krishan, Doraiswamy Brinda
Department of Surgery, Nassau University Medical Center, 2201 Hempstead Turnpike, East Meadow, NY, 11554, USA.
Department of Pediatrics, Nassau University Medical Center, 2201 Hempstead Turnpike, East Meadow, NY, 11554, USA.
Emerg Radiol. 2019 Feb;26(1):45-52. doi: 10.1007/s10140-018-1645-4. Epub 2018 Sep 27.
To evaluate whether the emergency department usage of head computed tomography (CT) on pediatric patients with minor head trauma changed after publication of the Pediatric Emergency Care Applied Research Network (PECARN) head CT guidelines and to identify risk factors associated with performing head CT on patients without a PECARN guideline indication.
This retrospective study included 484 patients 18 years of age or younger who presented to the emergency department with head injury and a total Glasgow Coma Scale score ≥ 14 between September 2005 and July 2014. Based on the guideline publication date of September 2009, the study cohort was stratified into pre-guideline and post-guideline groups. Head CT performance, indications, and findings were compared between study periods. Logistic regression was used to identify risk factors associated with performing a non-indicated head CT.
The rate of head CTs performed did not significantly change in the post-guideline period (96.6% vs. 95.7%, p = 0.63). There was no significant difference in the proportion of head CTs performed in patients with indications for head CT (100.0% vs. 100.0%) nor in patients without an indication for head CT (85.7% vs. 82.6%, p = 0.65) between the study periods. Females were significantly more likely to have a non-indicated head CT (OR: 2.73, 95% CI: 1.67-4.45) performed.
Head CT ordering practices for pediatric patients with head injury did not change at a level I trauma center after publication of the PECARN head CT guidelines.
评估儿科急诊护理应用研究网络（PECARN）头部CT指南发布后，小儿轻度头部外伤患者在急诊科进行头部计算机断层扫描（CT）的情况是否发生变化，并确定在无PECARN指南指征的患者中进行头部CT检查的相关危险因素。
这项回顾性研究纳入了2005年9月至2014年7月期间因头部受伤且格拉斯哥昏迷量表总分≥14分而到急诊科就诊的484名18岁及以下患者。根据2009年9月的指南发布日期，将研究队列分为指南发布前和发布后两组。比较研究期间头部CT的检查情况、指征和结果。采用逻辑回归分析确定与进行无指征头部CT检查相关的危险因素。
指南发布后进行头部CT检查的比例没有显著变化（96.6%对95.7%，p = 0.63）。研究期间，有头部CT检查指征的患者进行头部CT检查的比例（100.0%对百100.0%）以及无头部CT检查指征的患者进行头部CT检查的比例（85.7%对82.6%，p = 0.65）均无显著差异。女性进行无指征头部CT检查的可能性显著更高（比值比：2.73，95%置信区间：1.67 - 4.45）。
PECARN头部CT指南发布后，一级创伤中心小儿头部受伤患者的头部CT检查医嘱开具情况没有改变。
