Multi‐centre study found that strict adherence to guidelines led to computed tomography scans being overused in children with minor head injuries
| Autor: | B Boersma, Ellen Tromp, Nicky Niele, Katja Heitink, Gavin W. ten Tusscher, Marlies A. van Houten, Maarten H. Biezeveld, Frans B. Plötz, Johannes B. van Goudoever, Matthijs Douma |
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| Přispěvatelé: | Amsterdam Reproduction & Development (AR&D), Amsterdam Gastroenterology Endocrinology Metabolism, ACS - Diabetes & metabolism, Graduate School, AGEM - Digestive immunity, AGEM - Endocrinology, metabolism and nutrition, Neonatology |
| Rok vydání: | 2019 |
| Předmět: |
Male
medicine.medical_specialty Medical Overuse 03 medical and health sciences 0302 clinical medicine Skull fracture 030225 pediatrics medicine Craniocerebral Trauma Humans Prospective Studies 030212 general & internal medicine Child business.industry Incidence (epidemiology) Glasgow Coma Scale Infant General Medicine Guideline medicine.disease Skull medicine.anatomical_structure Child Preschool Scalp Pediatrics Perinatology and Child Health Vomiting Female Observational study Guideline Adherence Radiology medicine.symptom Tomography X-Ray Computed business |
| Zdroj: | Acta Paediatrica, International Journal of Paediatrics, 108(9), 1695-1703. Wiley-Blackwell Acta paediatrica (Oslo, Norway, 108(9), 1695-1703. Wiley-Blackwell |
| ISSN: | 1651-2227 0803-5253 |
| DOI: | 10.1111/apa.14742 |
| Popis: | Aim: Our primary aim was to calculate the head computed tomography (CT) scan rate in children with a minor head injury (MHI) when the Dutch National guidelines were followed in clinical practice. The secondary aim was to determine the incidence of CT abnormalities and the guideline predictors associated with traumatic abnormalities. Methods: We performed a multi-centre, prospective observational cross-sectional study in the emergency departments of six hospitals in The Netherlands between 1 April 2015 and 31 December 2016. Results: Data on 1002 patients were studied and 69% of cases complied with the guidelines. The overall CT rate was 44% and the incidence of traumatic abnormal CT findings was 13%. CT scans were performed in 19% of children under two years of age, 48% of children between two and five years and 63% of children aged six years or more. Multivariate regression analysis for all age categories showed that CT abnormalities were predicted by a Glasgow Coma Scale of less than 15, suspicion of a basal skull fracture, vomiting and scalp haematomas or external lesions of the skull. Conclusion: Strict adherence to the Dutch national guidelines resulted in CT overuse. New guidelines are needed to safely reduce CT scan indications. |
| Databáze: | OpenAIRE |
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