title: Selecting children for head CT following head injury.
abstract: OBJECTIVE
  Indicators for head CT scan defined by the 2007 National Institute for Health and Care Excellence (NICE) guidelines were analysed to identify CT uptake, influential variables and yield.
  
  
  METHODS
  Cross-sectional study.
  
  
  METHODS
  Hospital inpatient units: England, Wales, Northern Ireland and the Channel Islands.
  
  
  METHODS
  Children (<15 years) admitted to hospital for more than 4 h following a head injury (September 2009 to February 2010).
  
  
  METHODS
  CT scan.
  
  
  METHODS
  Number of children who had CT, extent to which NICE guidelines were followed and diagnostic yield.
  
  
  RESULTS
  Data on 5700 children were returned by 90% of eligible hospitals, 84% of whom were admitted to a general hospital. CT scans were performed on 30.4% of children (1734), with a higher diagnostic yield in infants (56.5% (144/255)) than children aged 1 to 14 years (26.5% (391/1476)). Overall, only 40.4% (984 of 2437 children) fulfilling at least one of the four NICE criteria for CT actually underwent one. These children were much less likely to receive CT if admitted to a general hospital than to a specialist centre (OR 0.52 (95% CI 0.45 to 0.59)); there was considerable variation between healthcare regions. When indicated, children >3 years were much more likely to have CT than those <3 years (OR 2.35 (95% CI 2.08 to 2.65)).
  
  
  CONCLUSIONS
  Compliance with guidelines and diagnostic yield was variable across age groups, the type of hospital and region where children were admitted. With this pattern of clinical practice the risks of both missing intracranial injury and overuse of CT are considerable.
authors.affiliation: College of Biomedical and Life Sciences, School of Medicine, Cardiff University, Cardiff, Wales, UK.
authors.forename: A
authors.initials: A
authors.lastname: Kemp
authors.affiliation: College of Biomedical and Life Sciences, School of Medicine, Cardiff University, Cardiff, Wales, UK.
authors.forename: E
authors.initials: E
authors.lastname: Nickerson
authors.affiliation: College of Biomedical and Life Sciences, School of Medicine, Cardiff University, Cardiff, Wales, UK.
authors.forename: L
authors.initials: L
authors.lastname: Trefan
authors.affiliation: Research fellow CMACE (at the time of the project). Placements Manager at Kids Company, London, UK.
authors.forename: R
authors.initials: R
authors.lastname: Houston
authors.affiliation: Paediatric Intensive Care Unit, Southampton Children's Hospital, Southampton, UK.
authors.forename: P
authors.initials: P
authors.lastname: Hyde
authors.affiliation: Consultant in Intensive Care, Birmingham Children's Hospital, Birmingham, UK.
authors.forename: G
authors.initials: G
authors.lastname: Pearson
authors.affiliation: Department of Neurosurgery, Bristol Hospital for Children, Bristol, UK.
authors.forename: R
authors.initials: R
authors.lastname: Edwards
authors.affiliation: Senior Lecturer in Epidemiology, Leeds Institute of Cardiovascular and Metabolic Medicine, School of Medicine, University of Leeds, Leeds, UK.
authors.forename: R C
authors.initials: RC
authors.lastname: Parslow
authors.affiliation: Paediatric Emergency Medicine Consultant, Imperial College NHS Healthcare Trust, London, UK.
authors.forename: I
authors.initials: I
authors.lastname: Maconochie
mesh_terms: D000058:Accidental Falls / Q000706:statistics & numerical data; D000061:Accidents, Home; D000063:Accidents, Traffic / Q000706:statistics & numerical data; D000293:Adolescent; D017677:Age Distribution; D002648:Child; D002675:Child, Preschool; D006259:Craniocerebral Trauma / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000209:etiology; D019091:Critical Pathways; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D018579:Patient Selection; D015995:Prevalence; D012887:Skull Fractures / Q000000981:diagnostic imaging / Q000453:epidemiology; D061665:Time-to-Treatment; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data*; D016896:Treatment Outcome; D014474:Unconsciousness / Q000000981:diagnostic imaging / Q000453:epidemiology; D006113:United Kingdom / Q000453:epidemiology; D019564:Unnecessary Procedures / Q000706:statistics & numerical data
keywords: Accident & Emergency; Imaging