Variation in utilization of computed tomography scanning for the investigation of minor head trauma in children: a Canadian experience.
OBJECTIVE
To compare the utilization rates of CT scans in investigating minor head trauma in children in Canada, to identify the injuries determined by these scans, and to identify clinical findings that are highly associated with its diagnosis and the injury itself.


METHODS
A retrospective cohort study involving nine pediatric hospitals in Canada was conducted. A structured data collection method was used. Inclusion criteria included age 16 years or less, history of blunt head trauma, and a Glasgow Coma Scale score (GCS) greater than or equal to 13. Data collected included demographic information, type of injury, relevant clinical information, computed tomography (CT) scan data, and clinical outcome. Clinical findings associated with CT scan and positive CT scan were identified using logistic regression.


RESULTS
One thousand one hundred sixty-four children were included in the study. One hundred seventy-one (15%) had a CT scan, of which 60 (35%) were abnormal. There was a significant difference in the rate of ordering of CT scans among the participating hospitals, but no significant difference in the rate of abnormal CT scans. Mechanism of injury, GCS, and loss of consciousness were significantly related to the presence of an abnormal CT scan.


CONCLUSIONS
Although there is a significant difference in the utilization of CT scans to investigate minor head trauma in children across Canada, there is no significant difference in the frequency of head injuries in these patients. This suggests that it may be possible to determine clinical criteria that are predictive of a head injury in these patients.
Department of Pediatrics, University of Alberta, Health Sciences Centre, Edmonton, Canada. terry.klassen@ualberta.ca
T P
TP
Klassen
M H
MH
Reed
I G
IG
Stiell
C
C
Nijssen-Jordan
M
M
Tenenbein
G
G
Joubert
A
A
Jarvis
G
G
Baldwin
D
D
St-Vil
C
C
Pitters
F
F
Belanger
D
D
McConnell
K
K
Vandemheen
M G
MG
Hamilton
T
T
Sutcliffe
M
M
Colbourne
D000293:Adolescent; D000704:Analysis of Variance; D002170:Canada; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D016001:Confidence Intervals; D006259:Craniocerebral Trauma / Q000175:diagnosis / Q000000981:diagnostic imaging*; D004635:Emergency Medicine / Q000706:statistics & numerical data; D005260:Female; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data; D006801:Humans; D015601:Injury Severity Score; D016015:Logistic Models; D008297:Male; D011336:Probability; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods / Q000706:statistics & numerical data*