title: Hospital-level factors associated with use of pediatric radiation dose-reduction protocols for head CT: results from a national survey.
abstract: OBJECTIVE
  To examine hospital-level factors associated with the use of a dedicated pediatric dose-reduction protocol and protective shielding for head CT in a national sample of hospitals.
  
  
  METHODS
  A mixed-mode (online and paper) survey was administered to a stratified random sample of US community hospitals (N = 751). Respondents provided information on pediatric head CT scanning practices, including use of a dose-reduction protocol. Modified Poisson regression analyses describe the relative risk (RR) of not reporting the use of a pediatric dose-reduction protocol or protective shielding; multivariable analyses adjust for census region, trauma level, children's hospital status, and bed size.
  
  
  RESULTS
  Of hospitals that were contacted, 38 were ineligible (no CT scanner, hospital closed, do not scan infants), 1 refused, and 253 responded (35.5% response rate). Across all hospitals, 92.6% reported using a pediatric dose-reduction protocol. Modified Poisson regression showed that small hospitals (0-50 beds) were 20% less likely to report using a protocol than large hospitals (>150 beds) (RR: 0.80, 95% confidence interval [CI]: 0.65-0.99; adjusted for covariates). Teaching hospitals were more likely to report using a protocol (RR: 1.10, 95% CI: 1.02-1.19; adjusted for covariates). After adjusting for covariates, children's hospitals were significantly less likely to report using protective shielding than nonchildren's hospitals (RR: 0.64, 95% CI: 0.56-0.73), though this may be due to more advanced scanner type.
  
  
  CONCLUSIONS
  Results from this study provide guidance for tailored educational campaigns and quality improvement interventions to increase the adoption of pediatric dose-reduction efforts.
authors.affiliation: College of Nursing, Washington State University, Spokane, Washington; Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington; Department of Pediatrics, School of Medicine, University of Washington, Seattle, Washington. Electronic address: janessa.graves@wsu.edu.
authors.forename: Janessa M
authors.initials: JM
authors.lastname: Graves
authors.affiliation: Department of Radiology, School of Medicine, University of Washington, Seattle, Washington; Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington.
authors.forename: Kalpana M
authors.initials: KM
authors.lastname: Kanal
authors.affiliation: Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington; Department of Anesthesiology and Pain Medicine, School of Medicine, University of Washington, Seattle, Washington; Department of Pediatrics, School of Medicine, University of Washington, Seattle, Washington.
authors.forename: Monica S
authors.initials: MS
authors.lastname: Vavilala
authors.affiliation: Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Kimberly E
authors.initials: KE
authors.lastname: Applegate
authors.affiliation: Department of Radiology, School of Medicine, University of Washington, Seattle, Washington; Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington; Comparative Effectiveness, Cost and Outcomes Research Center, University of Washington, Seattle, Washington; Department of Health Service, University of Washington School of Public Health, Seattle, Washington.
authors.forename: Jeffrey G
authors.initials: JG
authors.lastname: Jarvik
authors.affiliation: Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington; Department of Pediatrics, School of Medicine, University of Washington, Seattle, Washington; Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington.
authors.forename: Frederick P
authors.initials: FP
authors.lastname: Rivara
mesh_terms: D002648:Child; D002675:Child, Preschool; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006257:Head / Q000000981:diagnostic imaging*; D019538:Health Care Surveys; D006764:Hospitals, Community / Q000145:classification / Q000592:standards / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010372:Pediatrics / Q000592:standards; D017410:Practice Guidelines as Topic; D011829:Radiation Dosage; D011835:Radiation Protection / Q000592:standards* / Q000706:statistics & numerical data*; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data*; D014481:United States
keywords: CT imaging protocols; national survey; pediatric head CT; radiation dose; trauma center