Reducing CT Scans for Children at Low Risk of Clinically Important Traumatic Brain
Injury: A Heads Up on How We Are Doing
LewisFirst, MD, MS, Editor in Chief, Pediatrics
In 2009, the Pediatric Emergency Care Applied Research Network (PECARN) established
after a comprehensive prospective study clinical guidelines for when to obtain a CT following mild traumatic injury. Given the risks of excess
radiation due to CT scans in children, the PECARN work was intended to decrease CT
scans for low-risk children. So how are we doing at decreasing unnecessary CT scans?
Are we following the PECARN criteria and as a result reducing radiation exposure?
Burstein et al. (10.1542/peds.2018-0814) share with us annualized results of CT scans obtained from a nationally representative
collection of ED from the National Ambulatory Care Survey 2007-2015. The good news
is that in dedicated children’s and teaching hospitals, there was a significant decline
in CT scans. The bad news is that nearly all of the potentially unnecessary CT scans
were in 90% non-pediatric general hospitals, in which there was no change in rate
of CT scans ordered for mild traumatic brain injury.
Why was there no improvement in these general emergency departments despite the strong
evidence-based guidelines from PECARN? We asked hospitalist Dr. Eric Coons and intensivist
Dr. Susan Bratton from Utah to weigh in with an accompanying commentary (10.1542/peds.2018-2137). They point out the lack of diffusion of innovation and change in pediatric care
processes outside of children’s hospitals and call for improvement in how we can be
more inclusive of communicating the evidence and in turn the need to reduce unnecessary
CT scans for minor head injuries in these general hospitals. Both the article and
commentary require more than a quick scan, but the result of doing so may result in
less children getting radiation exposure they don’t need or require. Check out both
articles and learn more.