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Assessment of Pediatric Neurotrauma Imaging Appropriateness at a Level I Pediatric Trauma Center.

Authors
  • Rao, Sevith1
  • Rao, Sishir1
  • Rincon, Sandra1
  • Caruso, Paul1
  • Ptak, Thomas1
  • Raja, Ali S2
  • Prabhakar, Anand M1
  • Harvey, H Benjamin3
  • 1 Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
  • 2 Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
  • 3 Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Institute for Technology Assessment, Massachusetts General Hospital, Boston, Massachusetts. Electronic address: [email protected]
Type
Published Article
Journal
Journal of the American College of Radiology : JACR
Publication Date
Jul 01, 2016
Volume
13
Issue
7
Pages
788–793
Identifiers
DOI: 10.1016/j.jacr.2016.02.022
PMID: 27084071
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

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. 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. 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). 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. Copyright © 2016 American College of Radiology. Published by Elsevier Inc. All rights reserved.

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