title: Variation in specialists' reported hospitalization practices of children sustaining blunt head trauma.
abstract: BACKGROUND
  Questions surround the appropriate emergency department (ED) disposition of children who have sustained blunt head trauma (BHT). Our objective was to identify physician disposition preferences of children with blunt head trauma (BHT) and varying computed tomography (CT) findings.
  
  
  METHODS
  WE SURVEYED PEDIATRIC AND GENERAL EMERGENCY PHYSICIANS (EP), PEDIATRIC NEUROSURGEONS (PNSURG), GENERAL NEUROSURGEONS (GNSURG), PEDIATRIC SURGEONS (PSURG) AND TRAUMA SURGEONS REGARDING CARE OF TWO HYPOTHETICAL PATIENTS: Case 1: a 9-year-old who fell 10 feet and Case 2: an 11-month-old who fell 5 feet. We presented various CT findings and asked physicians about disposition preferences. We evaluated predictors of patient discharge using multivariable regression analysis adjusting for hospital and ED characteristics and clinician experience. Pediatric EPs served as the reference group.
  
  
  RESULTS
  Of 2,341 eligible surveyed, 715 (31%) responded. Most would discharge children with linear skull fractures (Case 1, 71%; Case 2, 62%). Neurosurgeons were more likely to discharge children with small subarachnoid hemorrhages (Case 1 PNSurg OR 6.87, 95% CI 3.60, 13.10; GNSurg OR 6.54, 95% CI 2.38, 17.98; Case 2 PNSurg OR 5.38, 95% CI 2.64, 10.99; GNSurg OR 6.07, 95% CI 2.08, 17.76). PSurg were least likely to discharge children with any CT finding, even linear skull fractures (Case 1 OR 0.14, 95% CI 0.08, 0.23; Case 2 OR 0.18, 95% CI 0.11, 0.30). Few respondents (<6%) would discharge children with small intraventricular, subdural, or epidural bleeds.
  
  
  CONCLUSIONS
  Substantial variation exists between specialties in reported hospitalization practices of neurologically-normal children with BHT and traumatic CT findings.
authors: University of California Davis, Department of Pediatrics, Davis, California ; University of California Davis, Department of Emergency Medicine, Davis, California.
authors: Cheryl W
authors: CW
authors: Vance
authors: Moon O
authors: MO
authors: Lee
authors: James F
authors: JF
authors: Holmes
authors: Peter E
authors: PE
authors: Sokolove
authors: Michael J
authors: MJ
authors: Palchak
authors: Beth A
authors: BA
authors: Morris
authors: Nathan
authors: N
authors: Kuppermann