title: Assessment of Pediatric Neurotrauma Imaging Appropriateness at a Level I Pediatric Trauma Center.
abstract: OBJECTIVE
  The aim of this study was to assess the prevalence of appropriate neuroimaging on the basis of the ACR Appropriateness Criteria among pediatric patients presenting after head trauma to a level I emergency department.
  
  
  METHODS
  A retrospective emergency department record review was performed for patients <18 years of age undergoing head CT or MRI for the indication "head trauma" between January 2013 and December 2014. Clinical history and symptoms were compared with the ACR Appropriateness Criteria; the indication was deemed appropriate for ratings of ≥7. Patients were analyzed by age, gender, presentation, imaging obtained, follow-up, treatment, and outcomes.
  
  
  RESULTS
  Among 207 patients, 120 (58%) were imaged with CT and 107 (52%) with MRI; 20 patients underwent both CT and MRI. One hundred eighty-seven patients (90.3%) were appropriately imaged, with 90.0% of CT studies (108 of 120) deemed appropriate and 91.6% of MRI studies (98 of 107) deemed appropriate. Younger patients were more likely to be inappropriately imaged with CT or MRI than older patients (P = .02 and P < .01, respectively). Patients undergoing CT were older (mean age 9.9 ± 5.8 years) and more likely to be male (85.2%) than those undergoing MRI (5.6 ± 5.6 years and 55.1%, respectively) (P < .01 and P < .001, respectively). The diagnostic yield of positive imaging findings for intracranial trauma was significantly lower in the MRI group (P < .01), and patients undergoing MRI were significantly more likely to return to baseline with conservative management (P < .01).
  
  
  CONCLUSIONS
  Most pediatric patients undergoing neuroimaging for head trauma did so appropriately per ACR guidelines and had symptom resolution with conservative management. The minority not imaged appropriately represent a target for quality improvement efforts.
authors.affiliation: Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
authors.forename: Sevith
authors.initials: S
authors.lastname: Rao
authors.affiliation: Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
authors.forename: Sishir
authors.initials: S
authors.lastname: Rao
authors.affiliation: Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
authors.forename: Sandra
authors.initials: S
authors.lastname: Rincon
authors.affiliation: Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
authors.forename: Paul
authors.initials: P
authors.lastname: Caruso
authors.affiliation: Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
authors.forename: Thomas
authors.initials: T
authors.lastname: Ptak
authors.affiliation: Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
authors.forename: Ali S
authors.initials: AS
authors.lastname: Raja
authors.affiliation: Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
authors.forename: Anand M
authors.initials: AM
authors.lastname: Prabhakar
authors.affiliation: Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Institute for Technology Assessment, Massachusetts General Hospital, Boston, Massachusetts. Electronic address: hbharvey@mgh.harvard.edu.
authors.forename: H Benjamin
authors.initials: HB
authors.lastname: Harvey
mesh_terms: D001900:Boston / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D006259:Craniocerebral Trauma / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D059906:Neuroimaging / Q000592:standards* / Q000706:statistics & numerical data*; D017410:Practice Guidelines as Topic; D015995:Prevalence; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014193:Trauma Centers / Q000706:statistics & numerical data*; D019564:Unnecessary Procedures / Q000706:statistics & numerical data*; D014600:Utilization Review
keywords: CT; Image Gently; MRI; Radiology; TBI; appropriateness criteria; concussion; diagnostic radiation; head trauma; pediatrics; utilization