title: Blunt head trauma in children in a community health care setting: outcomes and variables associated with the use of computed tomography.
abstract: OBJECTIVE
  To evaluate the incidence of clinically important traumatic brain injury (ciTBI) in children presenting to a community hospital setting and identified factors associated with computed tomography (CT) use.
  
  
  METHODS
  Retrospective cohort study of consecutive children presenting with blunt head trauma to a community emergency department or clinic over 12 months. Logistic regression models were used to compare differences in characteristics between patients who received and did not receive CT scans.
  
  
  RESULTS
  Of 1007 patients, 62% male, age 14 days-18 years (270 <2 years, 737 ≥2 years), 189 (18%) had CT scans, 2 (0.2%) showed evidence of ciTBI on CT, 13 (1.3%) hospitalized, and none required neurosurgical intervention or died. Factors associated with CT use in patients ≥2 years: history of vomiting (OR 4.08, 95% CI 2.08-7.99, P < .001), change in behavior (OR 2.83, 95% CI 1.63-4.91, P < .001), headache (OR 3.4, 95% CI 1.87-6.16, P < .001), loss of consciousness (OR 2.83, 95% CI 1.38-5.8, P = .004), and abnormal neurologic examination (OR 26.18, 95% CI 2.26-303.05, P = .009). Patients were more likely to receive CT scans in community emergency departments than clinics (OR 7.04, 95% CI 2.40-20.65, P = .002).
  
  
  CONCLUSIONS
  Patients in our community hospital setting are at low risk of ciTBI. The clinical indicators used to determine the need for CT in patients with more significant mechanisms of injury to pediatric or academic centers may not apply to this group. Future studies are required to determine which clinical indications are significant in this setting.
authors.affiliation: Department of Pediatrics, Kaiser Permanente, Orange County, Anaheim, CA, USA.
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Van Winkle
authors.forename: Ngoc J
authors.initials: NJ
authors.lastname: Ho
authors.forename: Casey A
authors.initials: CA
authors.lastname: Rodriguez
authors.forename: Laura
authors.initials: L
authors.lastname: Sirikulvadhana
authors.forename: Jane A
authors.initials: JA
authors.lastname: McMillan
mesh_terms: D000293:Adolescent; D000465:Algorithms; D002648:Child; D002675:Child, Preschool; D003153:Community Health Services; D005260:Female; D016489:Head Injuries, Closed / Q000000981:diagnostic imaging*; D006764:Hospitals, Community; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D009460:Neurologic Examination; D014057:Tomography, X-Ray Computed