Variation in CT use for paediatric head injuries across different types of emergency departments in Australia and New Zealand.

Autor:	Wilson CL; Emergency Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia.; Paediatric Research in Emergency Departments International Collaborative, Murdoch Children's Research Institute, Parkville, Victoria, Australia., Tavender EJ; Emergency Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia.; Paediatrics, University of Melbourne, Parkville, Victoria, Australia., Phillips NT; Emergency Department, Queensland Children's Hospital, South Brisbane, Queensland, Australia.; Child Health Research Centre, University of Queensland, Brisbane, Queensland, Australia., Hearps SJ; Clinical Sciences, Murdoch Childrens Research Institute, Parkville, Victoria, Australia., Foster K; Paediatric Research in Emergency Departments International Collaborative, Murdoch Children's Research Institute, Parkville, Victoria, Australia.; School of Nursing and Midwifery, University of Southern Queensland, Ipswich, Queensland, Australia., O'Brien SL; Emergency, Perth Children's Hospital, Nedlands, Western Australia, Australia.; School of Nursing, Midwifery & Paramedicine, Curtin University, Perth, Western Australia, Australia., Borland ML; Emergency Department, Perth Children's Hospital, Perth, Western Australia, Australia.; Divisions of Paediatrics and Emergency Medicine, School of Medicine, The University of Western Australia, Perth, Western Australia, Australia., Watkins GO; Paediatric Research in Emergency Departments International Collaborative, Murdoch Children's Research Institute, Parkville, Victoria, Australia.; Emergency Department, Sutherland Hospital, Caringbah, New South Wales, Australia., McLeod L; Emergency Department, Coffs Harbour Base Hospital, Coffs Harbour, New South Wales, Australia., Putland M; Emergency Department, Bendigo Health-Bendigo Hospital Campus, Bendigo, Victoria, Australia., Priestley S; Emergency Department, Sunshine Coast University Hospital, Sunshine Coast, Queensland, Australia., Brabyn C; Emergency Department, Waikato District Health Board, Hamilton, New Zealand., Ballard DW; Northern California Division of Research, Kaiser Permanente, Oakland, California, USA., Craig S; Emergency Department, Monash Medical Centre Clayton, Clayton, Victoria, Australia.; Department of Paediatrics, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia., Dalziel SR; Emergency Department, Starship Children's Health, Auckland, New Zealand.; Departments of Surgery and Paediatrics: Child and Youth Health, The University of Auckland, Auckland, Auckland, New Zealand., Oakley E; Paediatrics, University of Melbourne, Parkville, Victoria, Australia.; Emergency Department, Royal Children's Hospital, Parkville, Victoria, Australia., Babl FE; Emergency Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia franz.babl@rch.org.au.; Emergency Department, Royal Children's Hospital, Parkville, Victoria, Australia.; Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia.
Jazyk:	angličtina
Zdroj:	Emergency medicine journal : EMJ [Emerg Med J] 2020 Nov; Vol. 37 (11), pp. 686-689. Date of Electronic Publication: 2020 Aug 17.
DOI:	10.1136/emermed-2020-209719
Abstrakt:	Objectives: CT of the brain (CTB) for paediatric head injury is used less frequently at tertiary paediatric emergency departments (EDs) in Australia and New Zealand than in North America. In preparation for release of a national head injury guideline and given the high variation in CTB use found in North America, we aimed to assess variation in CTB use for paediatric head injury across hospitals types. Methods: Multicentre retrospective review of presentations to tertiary, urban/suburban and regional/rural EDs in Australia and New Zealand in 2016. Children aged <16 years, with a primary ED diagnosis of head injury were included and data extracted from 100 eligible cases per site. Primary outcome was CTB use adjusted for severity (Glasgow Coma Scale) with 95% CIs; secondary outcomes included hospital length of stay and admission rate. Results: There were 3072 head injury presentations at 31 EDs: 9 tertiary (n=900), 11 urban/suburban (n=1072) and 11 regional/rural EDs (n=1100). The proportion of children with Glasgow Coma Score ≤13 was 1.3% in each type of hospital. Among all presentations, CTB was performed for 8.2% (95% CI 6.4 to 10.0) in tertiary hospitals, 6.6% (95% CI 5.1 to 8.1) in urban/suburban hospitals and 6.1% (95% CI 4.7 to 7.5) in regional/rural. Intragroup variation of CTB use ranged from 0% to 14%. The regional/rural hospitals admitted fewer patients (14.6%, 95% CI 12.6% to 16.9%, p<0.001) than tertiary and urban/suburban hospitals (28.1%, 95% CI 25.2% to 31.2%; 27.3%, 95% CI 24.7% to 30.1%). Conclusions: In Australia and New Zealand, there was no difference in CTB use for paediatric patients with head injuries across tertiary, urban/suburban and regional/rural EDs with similar intragroup variation. This information can inform a binational head injury guideline. Competing Interests: Competing interests: None declared. (© Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
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