Leva Ernest, Do Minh-Tu, Grieco Rachael, Petrova Anna
Department of Pediatric, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 08903-0019, USA.
Children (Basel). 2023 Jul 24;10(7):1274. doi: 10.3390/children10071274.
This study demonstrates the trend of computed tomography (CT) usage for children with mild traumatic brain injury (mTBI) in the context of the initiation of the to promote the Pediatric Emergency Care Applied Research Network (PECARN) rules at the acute care hospitals in New Jersey. We used administrative databases of 10 children's and 59 general hospitals to compare CT rates before 2014-2015, during 2016, and after the initiation of the program (2017-2019). The CT usage rates at baseline and the end of surveillance in children's hospitals (19.2% and 14.2%) were lower than in general hospitals (36.7% and 21.0%), < 0.0001. The absolute mean difference from baseline to the end of surveillance in children's hospitals was 5.1% compared to a high of 9.7% in general hospitals, medium-high with 13.2%, and 14.0% in a medium volume of pediatric patients ( < 0.001-0.0001). The time-series model demonstrates a positive trend of CT reduction in pediatric patients with mTBI within four years of the program's implementation ( < 0.03-0.001). The primary CT reduction was recorded during the year of program implementation. Regression analysis revealed the significant role of a baseline CT usage rate in predicting the level of CT reduction independent of the volume of pediatric patients and type of hospital.
本研究展示了在新泽西州急诊医院推行儿科急诊护理应用研究网络（PECARN）规则的背景下，轻度创伤性脑损伤（mTBI）患儿计算机断层扫描（CT）的使用趋势。我们使用了10家儿童医院和59家综合医院的管理数据库，比较了2014 - 2015年之前、2016年期间以及该项目启动后（2017 - 2019年）的CT使用率。儿童医院基线期和监测期末的CT使用率（分别为19.2%和14.2%）低于综合医院（分别为36.7%和21.0%），P < 0.0001。儿童医院从基线到监测期末的绝对平均差异为5.1%，而综合医院高达9.7%，儿科患者数量中等偏高的医院为13.2%，儿科患者数量中等的医院为14.0%（P < 0.001 - 0.0001）。时间序列模型显示，在该项目实施的四年内，mTBI儿科患者的CT使用率呈下降趋势（P < 0.03 - 0.001）。主要的CT使用率下降记录在项目实施当年。回归分析显示，基线CT使用率在预测CT使用率下降水平方面具有显著作用，与儿科患者数量和医院类型无关。
