Reduction of paediatric head CT utilisation at a rural general hospital emergency department

BMJ Qual Saf. 2020 Nov;29(11):912-920. doi: 10.1136/bmjqs-2019-010322. Epub 2020 Feb 28.


Background: Blunt head injury is a common pediatric injury and often evaluated in general emergency departments. It estimated that 50% of children will undergo a head computed tomography (CT), often unnecessarily exposing the child to ionizing radiation. Pediatric academic centers have shown quality improvement (QI) measures can reduce head CT rates within their emergency departments. We aimed to reduce head CT utilization at a rural community emergency department.

Methods: Children presenting with a complaint of blunt head injury and were evaluated with or without a head CT. Head CT rate was the primary outcome. We developed a series of interventions and presented these to the general emergency department over the duration of the study. The pre and intervention data was analysed with control charts.

Results: The preintervention and intervention groups consisted of 576 children: 237 patients with a median age of 8.0 years and 339 patients with a median age of 9.00 years (p=0.54), respectively. The preintervention HCT rate was 41.8% (95% CI 35.6% to 48.1%) and the postintervention rate was 27.7% (95% CI 23.3% to 32.7%), a decrease of 14.1% (95% CI 6.2% to 21.9%, p=0.0004). During the intervention period, there was a decrease in HCT rate of one per month (OR 0.96, 95% CI 0.92 to 1.00, p=0.07). The initial series of interventions demonstrated an incremental decrease in HCT rates corresponding with a special cause variation.

Conclusion: The series of interventions dispersed over the intervention period was an effective methodology and successfully reduced HCT utilisation among children with blunt head injury at a rural community emergency department.

Keywords: Continuous quality improvement; Control charts, run charts; Emergency department; Healthcare quality improvement; Paediatrics.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Child
  • Child, Preschool
  • Emergency Service, Hospital
  • Female
  • Head Injuries, Closed
  • Hospitals, General
  • Humans
  • Infant
  • Male
  • Rural Population*
  • Tomography, X-Ray Computed