title: Emergency department practice variation in computed tomography use for children with minor blunt head trauma.
abstract: OBJECTIVE
  To describe factors associated with computed tomography (CT) use for children with minor blunt head trauma that are evaluated in emergency departments.
  
  
  METHODS
  Planned secondary analysis of a prospective observational study of children <18 years with minor blunt head trauma between 2004 and 2006 at 25 emergency departments. CT scans were obtained at the discretion of treating clinicians. We risk-adjusted patients for clinically important traumatic brain injuries and performed multivariable regression analyses. Outcome measures were rates of CT use by hospital and by clinician training type.
  
  
  RESULTS
  CT rates varied between 19.2% and 69.2% across hospitals. Risk adjustment had little effect on the differential rate of CT use. In low- and middle-risk patients, clinicians obtained CTs more frequently at suburban and nonfreestanding children's hospitals. Physicians with emergency medicine (EM) residency training obtained CTs at greater rates than physicians with pediatric residency or pediatric EM training. In multivariable analyses, compared with pediatric EM-trained physicians, the OR for CT use among EM-trained physicians in children <2 years was 1.24 (95% CI 1.04-1.46), and for children >2 years was 1.68 (95% CI 1.50-1.89). Physicians of all training backgrounds, however, overused CT scans in low-risk children.
  
  
  CONCLUSIONS
  Substantial variation exists in the use of CT for children with minor blunt head trauma not explained by patient severity or rates of positive CT scans or clinically important traumatic brain injuries.
authors.affiliation: Department of Emergency Medicine and Pediatrics, University of Michigan, Ann Arbor, MI. Electronic address: stanleyr@umich.edu.
authors.forename: Rachel M
authors.initials: RM
authors.lastname: Stanley
authors.affiliation: Division of Emergency Medicine, Michigan State University College of Human Medicine, Helen DeVos Children's Hospital, Grand Rapids, MI.
authors.forename: John D
authors.initials: JD
authors.lastname: Hoyle
authors.affiliation: Department of Pediatrics, Columbia University College of Physicians and Surgeons, New York, NY.
authors.forename: Peter S
authors.initials: PS
authors.lastname: Dayan
authors.affiliation: Department of Emergency Medicine, Children's National Medical Center, George Washington School of Medicine, Washington, DC.
authors.forename: Shireen
authors.initials: S
authors.lastname: Atabaki
authors.affiliation: Department of Pediatrics, Harvard Medical School, Boston, MA.
authors.forename: Lois
authors.initials: L
authors.lastname: Lee
authors.affiliation: Department of Pediatrics, State University of New York at Buffalo and Women and Children's Hospital of Buffalo, Buffalo, NY.
authors.forename: Kathy
authors.initials: K
authors.lastname: Lillis
authors.affiliation: Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI.
authors.forename: Marc H
authors.initials: MH
authors.lastname: Gorelick
authors.affiliation: Department of Pediatrics, University of Utah and PECARN Data Coordinating Center, Salt Lake City, UT.
authors.forename: Richard
authors.initials: R
authors.lastname: Holubkov
authors.affiliation: Department of Pediatrics, University of Utah and PECARN Data Coordinating Center, Salt Lake City, UT.
authors.forename: Michelle
authors.initials: M
authors.lastname: Miskin
authors.affiliation: Department of Emergency Medicine, University of California Davis School of Medicine, Davis, CA.
authors.forename: James F
authors.initials: JF
authors.lastname: Holmes
authors.affiliation: Department of Pediatrics, University of Utah and PECARN Data Coordinating Center, Salt Lake City, UT.
authors.forename: J Michael
authors.initials: JM
authors.lastname: Dean
authors.affiliation: Department of Emergency Medicine, University of California Davis School of Medicine, Davis, CA.
authors.forename: Nathan
authors.initials: N
authors.lastname: Kuppermann
mesh_terms: D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D016489:Head Injuries, Closed / Q000000981:diagnostic imaging*; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data; D006784:Hospitals, Teaching / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D015999:Multivariate Analysis; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011446:Prospective Studies; D018570:Risk Assessment; D012886:Skull / Q000000981:diagnostic imaging; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data*