Assessment of Pediatric Neurotrauma Imaging Appropriateness at a Level I Pediatric Trauma Center

Sevith Rao; Sishir Rao; Sandra Rincon; Paul Caruso; Thomas Ptak; Ali S Raja; Anand M Prabhakar; H Benjamin Harvey

doi:10.1016/j.jacr.2016.02.022

Assessment of Pediatric Neurotrauma Imaging Appropriateness at a Level I Pediatric Trauma Center

J Am Coll Radiol. 2016 Jul;13(7):788-93. doi: 10.1016/j.jacr.2016.02.022. Epub 2016 Apr 12.

Authors

Sevith Rao¹, Sishir Rao¹, Sandra Rincon¹, Paul Caruso¹, Thomas Ptak¹, Ali S Raja², Anand M Prabhakar¹, H Benjamin Harvey³

Affiliations

¹ Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
² Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
³ Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Institute for Technology Assessment, Massachusetts General Hospital, Boston, Massachusetts. Electronic address: hbharvey@mgh.harvard.edu.

PMID: 27084071
DOI: 10.1016/j.jacr.2016.02.022

Abstract

Purpose: The aim of this study was to assess the prevalence of appropriate neuroimaging on the basis of the ACR Appropriateness Criteria among pediatric patients presenting after head trauma to a level I emergency department.

Methods: A retrospective emergency department record review was performed for patients <18 years of age undergoing head CT or MRI for the indication "head trauma" between January 2013 and December 2014. Clinical history and symptoms were compared with the ACR Appropriateness Criteria; the indication was deemed appropriate for ratings of ≥7. Patients were analyzed by age, gender, presentation, imaging obtained, follow-up, treatment, and outcomes.

Results: Among 207 patients, 120 (58%) were imaged with CT and 107 (52%) with MRI; 20 patients underwent both CT and MRI. One hundred eighty-seven patients (90.3%) were appropriately imaged, with 90.0% of CT studies (108 of 120) deemed appropriate and 91.6% of MRI studies (98 of 107) deemed appropriate. Younger patients were more likely to be inappropriately imaged with CT or MRI than older patients (P = .02 and P < .01, respectively). Patients undergoing CT were older (mean age 9.9 ± 5.8 years) and more likely to be male (85.2%) than those undergoing MRI (5.6 ± 5.6 years and 55.1%, respectively) (P < .01 and P < .001, respectively). The diagnostic yield of positive imaging findings for intracranial trauma was significantly lower in the MRI group (P < .01), and patients undergoing MRI were significantly more likely to return to baseline with conservative management (P < .01).

Conclusions: Most pediatric patients undergoing neuroimaging for head trauma did so appropriately per ACR guidelines and had symptom resolution with conservative management. The minority not imaged appropriately represent a target for quality improvement efforts.

Keywords: CT; Image Gently; MRI; Radiology; TBI; appropriateness criteria; concussion; diagnostic radiation; head trauma; pediatrics; utilization.

MeSH terms

Boston / epidemiology
Child
Child, Preschool
Craniocerebral Trauma / diagnostic imaging*
Craniocerebral Trauma / epidemiology*
Female
Guideline Adherence / statistics & numerical data*
Humans
Male
Neuroimaging / standards*
Neuroimaging / statistics & numerical data*
Practice Guidelines as Topic
Prevalence
Reproducibility of Results
Sensitivity and Specificity
Trauma Centers / statistics & numerical data*
Unnecessary Procedures / statistics & numerical data*
Utilization Review