title: Variation in Computed Tomography Use for Evaluation of Head Injury in a Pediatric Emergency Department.
abstract: OBJECTIVE
  Recent research has shown significant variation in rates of computed tomography (CT) use among pediatric hospital emergency departments (ED) for evaluation of head injured children. We examined the rates of CT use by individual ED attending physicians for evaluation of head injured children in a pediatric hospital ED.
  
  
  METHODS
  We used an administrative database to identify children younger than 18 years evaluated for head injury from January 2011 through March 2013 at our children's hospital ED, staffed by pediatric emergency medicine (PEM) fellowship trained physicians and pediatricians. We excluded encounters with trauma team activation or previous head CT performed elsewhere. We excluded physicians whose patient volume was less than 1 standard deviation below the group mean.
  
  
  RESULTS
  After exclusions, we evaluated 5340 encounters for head injury by 27 ED attending physicians. For individual physicians, CT rates ranged from 12.4% to 37.3%, with a mean group rate of 28.4%. Individual PEM physician CT rates ranged from 18.9% to 37.3%, versus 12.4% to 31.8% for pediatricians. Of the 1518 encounters in which CT was done, 128 (8.4%) had a traumatic brain injury on CT, and 125 (8.2%) had a simple skull fracture without traumatic brain injury on CT. Patient factors associated with CT use included age younger than 2 years, higher triage acuity, arrival time of 10:00 PM to 6:00 AM, hospital admission, and evaluation by a PEM physician.
  
  
  CONCLUSIONS
  Physicians at our pediatric hospital ED varied in the use of CT for the evaluation of head-injured children.
authors.affiliation: From the *Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Utah School of Medicine; and †Systems Improvement Department, Intermountain Healthcare, Salt Lake City, UT.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Miescier
authors.forename: Nanette C
authors.initials: NC
authors.lastname: Dudley
authors.forename: Howard A
authors.initials: HA
authors.lastname: Kadish
authors.forename: Michael B
authors.initials: MB
authors.lastname: Mundorff
authors.forename: Howard M
authors.initials: HM
authors.lastname: Corneli
mesh_terms: D002648:Child; D002675:Child, Preschool; D006259:Craniocerebral Trauma / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008505:Medical Staff, Hospital; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data*