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.

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