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Variation in the use of skull radiographs by emergency physicians in young children with minor head trauma

Published online by Cambridge University Press:  04 March 2015

Benoit Carrière ,
Karine Clément  and
Jocelyn Gravel
Benoit Carrière*
Affiliation:
Division of Emergency Medicine, Department of Paediatrics, CHU Sainte-Justine, Université de Montréal, Montréal, QC
Karine Clément
Affiliation:
Division of Emergency Medicine, Department of Paediatrics, CHU Sainte-Justine, Université de Montréal, Montréal, QC
Jocelyn Gravel
Affiliation:
Division of Emergency Medicine, Department of Paediatrics, CHU Sainte-Justine, Université de Montréal, Montréal, QC
*
Division of Emergency Medicine, Department of Paediatrics, CHU Sainte-Justine, 3175 Chemin Côte Sainte-Catherine, Montreal, QC H3T 1C5; benoitcarriere@mac.com

Abstract

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Background:

Minor head trauma in young children is a major cause of emergency department visits. Conflicting guidelines exist regarding radiologic evaluation in such cases.

Objective:

To determine the practice pattern among Canadian emergency physicians for ordering skull radiographs in young children suffering from minor head trauma. Physicians were also surveyed on their willingness to use a clinical decision rule in such cases.

Design/Methods:

A self-administered email questionnaire was sent to all members of the Pediatric Emergency Research Canada (PERC) group. It consisted of clinical vignettes followed by multiple-option answers on the management plan. The study was conducted using the principles of the Dillman Tailored Design method and included multiple emailings to maximize the response rate. The research protocol received Institutional Review Board approval.

Results:

A total of 158 of 295 (54%) PERC members responded. Most participants were trained in pediatric emergency medicine and assessed more than 500 children per year. Imaging management for the vignettes was highly variable: 6 of the 11 case scenarios had a proportion of radiograph ordering between 20 and 80%. Ninety-five percent of respondents stated that they would apply a validated clinical decision rule for the detection of skull fracture in young children with minor head trauma. The minimum sensitivity deemed acceptable for such a rule was 98%.

Conclusion:

Canadian emergency physicians have a wide variation in skull radiography ordering in young children with minor head trauma. This variation, along with the need expressed by physicians, suggests that further research to develop a clinical decision rule is warranted.

Keywords

head traumapediatricsskull radiographsurvey
Type
Original Research • Recherche originale
Information
Canadian Journal of Emergency Medicine , Volume 16 , Issue 4 , July 2014 , pp. 281 - 287
Copyright
Copyright © Canadian Association of Emergency Physicians 2014

References

REFERENCES

1. Haydel, MJ, Shembekar, AD. Prediction of intracranial injury in children aged five years and older with loss of consciousness after minor head injury due to nontrivial mechanisms. Ann Emerg Med 2003;42:507–14, doi:10.1067/S0196-0644(03)00512-2.Google Scholar
2. Bazarian, JJ, McClung, J, Shah, MN, et al. Mild traumatic brain injury in the United States, 1998-2000. Brain Inj 2005;19:85–91, doi:10.1080/02699050410001720158.CrossRefGoogle ScholarPubMed
3. Schutzman, SA, Barnes, P, Duhaime, AC, et al. Evaluation and management of children younger than two years old with apparently minor head trauma: proposed guidelines. Pediatrics 2001;107:983–93, doi:10.1542/peds.107.5.983.CrossRefGoogle ScholarPubMed
4. Schunk, JE, Rodgerson, JD, Woodward, GA. The utility of head computed tomographic scanning in pediatric patients with normal neurologic examination in the emergency department. Pediatr Emerg Care 1996;12:160–5, doi:10.1097/00006565-199606000-00004.Google Scholar
5. Quayle, KS, Jaffe, DM, Kuppermann, N, et al. Diagnostic testing for acute head injury in children: when are head computed tomography and skull radiographs indicated? Pediatrics 1997;99:E11, doi:10.1542/peds.99.5.e11.Google Scholar
6. Ramundo, ML, McKnight, T, Kempf, J, Satkowiak, L. Clinical predictors of computed tomographic abnormalities following pediatric traumatic brain injury. Pediatr Emerg Care 1995;11:1–4, doi:10.1097/00006565-199502000-00001.Google Scholar
7. Gruskin, KD, Schutzman, SA. Head trauma in children younger than 2 years: are there predictors for complications? Arch Pediatr Adolesc Med 1999;153:15–20, doi:10.1001/archpedi.153.1.15.Google Scholar
8. Stewart, G, Meert, K, Rosenberg, N. Trauma in infants less than three months of age. Pediatr Emerg Care 1993;9:199–201, doi:10.1097/00006565-199308000-00004.Google Scholar
9. Dietrich, AM, Bowman, MJ, Ginn-Pease, ME, et al. Pediatric head injuries: can clinical factors reliably predict an abnormality on computed tomography? Ann Emerg Med 1993;22:1535–40, doi:10.1016/S0196-0644(05)81254-5.Google Scholar
10. Boulis, ZF, Dick, R, Barnes, NR. Head injuries in children—aetiology, symptoms, physical findings and x-ray wastage. Br J Radiol 1978;51:851–4, doi:10.1259/0007-1285-51-611-851.Google Scholar
11. Maguire, JL, Boutis, K, Uleryk, EM, et al. Should a headinjured child receive a head CT scan? A systematic review of clinical prediction rules. Pediatrics 2009;124:e145–54, doi:10.1542/peds.2009-0075.Google Scholar
12. Reed, MJ, Browning, JG, Wilkinson, AG, Beattie, T. Can we abolish skull x rays for head injury? Arch Dis Child 2005;90:859–64, doi:10.1136/adc.2004.053603.Google Scholar
13. Leonidas, JC, Ting, W, Binkiewicz, A, et al. Mild head trauma in children: when is a roentgenogram necessary? Pediatrics 1982;69:139–43.CrossRefGoogle ScholarPubMed
14. Ros, SP, Cetta, F. Are skull radiographs useful in the evaluation of asymptomatic infants following minor head injury? Pediatr Emerg Care 1992;8:328–30, doi:10.1097/00006565-199212000-00005.Google Scholar
15. Ersahin, Y, Gulmen, V, Palali, I, Mutluer, S. Growing skull fractures (craniocerebral erosion). Neurosurg Rev 2000;23:139–44, doi:10.1007/PL00011945.Google Scholar
16. Ersahin, Y, Mutluer, S, Mirzai, H, Palali, I. Pediatric depressed skull fractures: analysis of 530 cases. Childs Nerv Syst 1996;12:323–31, doi:10.1007/BF00301021.Google Scholar
17. Pezzotta, S, Silvani, V, Gaetani, P, et al. Growing skull fractures of childhood. Case report and review of 132 cases. J Neurosurg Sci 1985;29:129–35.Google ScholarPubMed
18. Gupta, SK, Reddy, NM, Khosla, VK, et al. Growing skull fractures: a clinical study of 41 patients. Acta Neurochir (Wien) 1997;139:928–32, doi:10.1007/BF01411301.CrossRefGoogle ScholarPubMed
19. Osmond, MH,Klassen, TP, Wells, GA, et al. CATCH: a clinical decision rule for the use of computed tomography in children with minor head injury. CMAJ 2010;182:341–8.Google Scholar
20. King, MA, Kanal, KM, Relyea-Chew, A, et al. Radiation exposure from pediatric head CT: a bi-institutional study. Pediatr Radiol 2009;39:1059–65, doi:10.1007/s00247-009-1327-1.Google Scholar
21. Stein, SC, Hurst, RW, Sonnad, SS. Meta-analysis of cranial CT scans in children. A mathematical model to predict radiation-induced tumors. Pediatr Neurosurg 2008;44:448–57, doi:10.1159/000172967.Google Scholar
22. Palchak, MJ, Holmes, JF, Vance, CW, et al. A decision rule for identifying children at low risk for brain injuries after blunt head trauma. Ann Emerg Med 2003;42:492–506, doi:10.1067/S0196-0644(03)00425-6.Google Scholar
23. Dunning, J, Daly, JP, Lomas, JP, et al. Derivation of the children’s head injury algorithm for the prediction of important clinical events decision rule for head injury in children. Arch Dis Child 2006;91:885–91, doi:10.1136/adc.2005.083980.Google Scholar
24. Beaudin, M, Saint-Vil, D, Ouimet, A, et al. Clinical algorithm and resource use in the management of children with minor head trauma. J Pediatr Surg 2007;42:849–52, doi:10.1016/j.jpedsurg.2006.12.038.Google Scholar
25. National Collaborating Centre for Acute Care. Head injury. Triage, assessment, investigation and early management of head injury in infants, children and adults. London, UK: National Institute for Health and Clinical Excellence; 2007.Google Scholar
26. Greenes, DS, Schutzman, SA. Infants with isolated skull fracture: what are their clinical characteristics, and do theyrequire hospitalization? Ann Emerg Med 1997;30:253–9, doi:10.1016/S0196-0644(97)70158-6.Google Scholar
27. Greenes, DS, Schutzman, SA. Clinical significance of scalp abnormalities in asymptomatic head-injured infants. Pediatr Emerg Care 2001;17:88–92, doi:10.1097/00006565-200104000-00002.Google Scholar
28. Chung, S, Schamban, N, Wypij, D, et al. Skull radiograph interpretation of children younger than two years: how good are pediatric emergency physicians? Ann Emerg Med 2004;43:718–22, doi:10.1016/j.annemergmed.2003.09.020.CrossRefGoogle ScholarPubMed
29. Asch, DA, Jedrziewski, MK, Christakis, NA. Response rates to mail surveys published in medical journals. J Clin Epidemiol 1997;50:1129–36, doi:10.1016/S0895-4356(97)00126-1.Google Scholar