title: Use of a mild traumatic brain injury guideline to reduce inpatient hospital imaging and charges.
abstract: OBJECTIVE
  In children, mild traumatic brain injuries (TBI) account for 70% to 90% of head injuries. Without clear guidelines, many of these children may be exposed to excess radiation owing to unnecessary imaging. The purpose of this study was to evaluate the impact of a mild TBI guideline in reducing hospital charges and repeated imaging of pediatric patients.
  
  
  METHODS
  Charts of all children who had at least one head computed tomography and were admitted to our level 1 trauma center with a blunt TBI and Glasgow Coma Scale of 13 to 15 were retrospectively reviewed. Patients were divided into 2 groups relative to the implementation of a TBI management guideline.
  
  
  RESULTS
  A total of 742 patients were included, 389 preguideline and 353 postguideline. Implementation of the guideline was associated with reductions in the average number of head computed tomographies performed (1.6 vs 1.3, P = .006), length of stay (2.3 vs 1.7 days, P < .0001), and overall hospital charges ($21,760 vs $13,980, P = .006). No children were readmitted for missed injuries.
  
  
  CONCLUSIONS
  Implementation of a simple guideline for the care of children with mild TBI can have significant impact on charges and length of stay while simultaneously reducing radiation exposure. Widespread implementation of such guidelines will improve efficiency without sacrificing quality of care in the management of mild TBI in the pediatric population.
authors.affiliation: Division of General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Department of Surgery, University of Cincinnati, Cincinnati, OH 45229-3039, USA.
authors.forename: Jillian
authors.initials: J
authors.lastname: Goldberg
authors.forename: Rebecca J
authors.initials: RJ
authors.lastname: McClaine
authors.forename: Becky
authors.initials: B
authors.lastname: Cook
authors.forename: Victor F
authors.initials: VF
authors.lastname: Garcia
authors.forename: Rebeccah L
authors.initials: RL
authors.lastname: Brown
authors.forename: Kerry
authors.initials: K
authors.lastname: Crone
authors.forename: Richard A
authors.initials: RA
authors.lastname: Falcone
mesh_terms: D000293:Adolescent; D001930:Brain Injuries / Q000000981:diagnostic imaging* / Q000191:economics*; D002648:Child; D002675:Child, Preschool; D003663:Decision Trees; D019983:Guideline Adherence; D017722:Hospital Charges; D006801:Humans; D007223:Infant; D015601:Injury Severity Score; D007297:Inpatients; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000191:economics* / Q000706:statistics & numerical data*