title: CT for pediatric, acute, minor head trauma: clinician conformity to published guidelines.
abstract: OBJECTIVE
  In 2001, pediatric radiologists participating in a panel discussion on CT dose reduction suggested that approximately 30% of head CT examinations were performed unnecessarily. With increasing concern regarding radiation exposure to children and imaging costs, this claim warrants objective study. The purpose of this study was to test the null hypothesis that 30% of head CT studies for clinical evaluation of children with acute, minor head trauma do not follow established clinical guidelines.
  
  
  METHODS
  Retrospective review of 182 consecutive patients with acute, minor head trauma from February 2009 to January 2010 at a tertiary care children's hospital emergency department was performed, and clinician adherence to published clinical guidelines for children younger than 2 years and children 2-20 years of age was determined. The binomial test was used for a null hypothesis of 30% unnecessary examinations against the actual percentage of head CTs deemed unnecessary on the basis of established guidelines. Statistical testing was performed for children younger than 2 years and 2-20 years of age.
  
  
  RESULTS
  For children younger than 2 years of age, 2 of 78 (2.6%; 95% CI, 0.5%-8.3%) and, for children 2-20 years of age, 12 of 104 (11.5%; CI, 6.4%-18.7%) did not conform to established guidelines. These percentages were significantly less than the hypothesized value of 30% (P < .001).
  
  
  CONCLUSIONS
  Clinician conformity to published guidelines for use of head CT in acute, minor head trauma is better than suggested by a 2001 informal poll of pediatric radiologists.
authors.affiliation: Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO 63110, USA. luke.linscott@gmail.com
authors.forename: L L
authors.initials: LL
authors.lastname: Linscott
authors.forename: M M
authors.initials: MM
authors.lastname: Kessler
authors.forename: D R
authors.initials: DR
authors.lastname: Kitchin
authors.forename: K S
authors.initials: KS
authors.lastname: Quayle
authors.forename: C F
authors.initials: CF
authors.lastname: Hildebolt
authors.forename: R C
authors.initials: RC
authors.lastname: McKinstry
authors.forename: S
authors.initials: S
authors.lastname: Don
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D006259:Craniocerebral Trauma / Q000000981:diagnostic imaging*; D004636:Emergency Service, Hospital / Q000592:standards; D005260:Female; D015600:Glasgow Coma Scale; D019983:Guideline Adherence; D006776:Hospitals, Pediatric; D006801:Humans; D008297:Male; D009485:Neuroradiography / Q000592:standards*; D010372:Pediatrics / Q000592:standards*; D012189:Retrospective Studies; D062606:Tertiary Care Centers; D019564:Unnecessary Procedures / Q000706:statistics & numerical data; D055815:Young Adult