title: Hospital Variation in Cervical Spine Imaging of Young Children With Traumatic Brain Injury.
abstract: Cervical imaging practices are poorly understood in young children with traumatic brain injury (TBI). We therefore sought to identify child-level and hospital-level factors associated with performance of cervical imaging of children with TBI from falls and abusive head trauma (AHT) and to describe across-hospital variation in cervical imaging performance. We hypothesized that imaging decisions would be influenced by hospital volume of young injured children.
  
  
  
  We performed a retrospective study of children younger than 2 years of age with TBI from 2009 to 2013 in the Premier Perspective Database. After adjustment for observed patient characteristics, we evaluated variation in advanced cervical imaging (computed tomography or magnetic resonance imaging) in children with AHT and TBI from falls.
  
  
  
  Of 2347 children with TBI, 18.7% were from abuse and 57.1% were from falls. Fifteen percent of children with TBI underwent advanced cervical imaging. Moderate or severe head injuries were associated with increased odds of cervical imaging in AHT (odds ratio 7.10; 95% confidence interval 2.75, 18.35) and falls (odds ratio 2.25; 95% confidence interval 1.19, 4.27). There was no association between annual hospital volume of injured children and cervical imaging performance. The adjusted probability of imaging across hospitals ranged from 4.3% to 84.3% in AHT and 3.1 to 39.0% in TBI from falls (P < .001).
  
  
  
  These results highlight variation across hospitals in adjusted probability of cervical imaging in AHT (nearly 20-fold) and TBI from falls (over 10-fold) not explained by observed patient characteristics. This variation suggests opportunities for further research to inform imaging practices.
authors: Division of General Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pa; Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, Philadelphia, Pa. Electronic address: henrym2@email.chop.edu.
authors: M Katherine
authors: MK
authors: Henry
authors: Department of Emergency Medicine and Injury Prevention Center, Alpert Medical School of Brown University and Hasbro Children's Hospital, Providence, RI.
authors: Mark R
authors: MR
authors: Zonfrillo
authors: Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, Pa.
authors: Benjamin
authors: B
authors: French
authors: Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, Philadelphia, Pa; PolicyLab, The Children's Hospital of Philadelphia, Philadelphia, PA.
authors: Lihai
authors: L
authors: Song
authors: Division of General Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pa; Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, Philadelphia, Pa; Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa.
authors: Chris
authors: C
authors: Feudtner
authors: Division of General Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pa; Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, Philadelphia, Pa; PolicyLab, The Children's Hospital of Philadelphia, Philadelphia, PA; Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa.
authors: Joanne N
authors: JN
authors: Wood
mesh_terms: D000058:Accidental Falls; D000070642:Brain Injuries, Traumatic / Q000000981:diagnostic imaging*; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging*; D002649:Child Abuse; D002675:Child, Preschool; D015331:Cohort Studies; D006259:Craniocerebral Trauma / Q000000981:diagnostic imaging; D016208:Databases, Factual; D005260:Female; D006761:Hospitals / Q000706:statistics & numerical data*; D061847:Hospitals, High-Volume; D061846:Hospitals, Low-Volume; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008279:Magnetic Resonance Imaging / Q000706:statistics & numerical data; D008297:Male; D016017:Odds Ratio; D010818:Practice Patterns, Physicians'; D012189:Retrospective Studies; D013124:Spinal Injuries / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data
keywords: accidental falls; child abuse; spinal injuries; traumatic brain injury