Computed tomography for head injuries in children: Change in Australian usage rates over time.
OBJECTIVE
Paediatric head injury is a common presentation to the ED. North American studies demonstrate increasing use of computed tomography (CT) brain scan (CTB) to investigate head injury. No such data exists for Australian EDs. The aim of this study was to describe CTB use in head injury over time in eight Australian EDs.


METHODS
Retrospective ED electronic database and medical imaging database audit was undertaken for the years 2001-2010 by International Classification of Diseases (ICD) 9 or 10 code for head injury in children <16 years. EDs and medical imaging departments of eight hospitals in Australia (five tertiary referral and three mixed departments). Data for ED presentations with head injury, and all CTB performed by medical imaging were merged to obtain a data set of CTB performed within 24 h for head injury-related attendances to the ED. Descriptive and comparative analysis of CTB rates was performed.


RESULTS
The rate of CTB over the decade was 10.2% (95% confidence interval (CI) 9.9-10.5). The annual rate varied from 9.5% (95% CI 8.2-10.9) to 12.5% (95% CI 11.2-13.9). CTB use did not increase over time. Median year of age at time of CT scan was 4 years, with an interquartile range of 1.5-9.4 years. Overall there was a 9.2% increase in the CTB scan rate for every additional year of age at presentation (95% CI 6.6-12.1; P < 0.001).


CONCLUSIONS
CTB use in head injuries did not increase during the study period, and rates of CTB were less than reported for North America.
Department of Emergency Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia.|Department of Emergency Research, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.
Ed
http://orcid.org/0000-0002-3712-6200
E
Oakley
Emergency Department, Royal Children's Hospital, Melbourne, Victoria, Australia.
Rachel
R
May
Emergency Department, Princess Margaret Hospital for Children, Perth, Western Australia, Australia.
Tobias
T
Hoeppner
Emergency Department, Canberra Hospital, Canberra, Australian Capital Territory, Australia.
Kam
K
Sinn
Department of Emergency Medicine, Townsville Hospital, Townsville, Queensland, Australia.
Jeremy
J
Furyk
Paediatric Emergency Department, Monash Medical Centre, Melbourne, Victoria, Australia.
Simon
S
Craig
Department of Emergency Medicine, Frankston Hospital, Melbourne, Victoria, Australia.
Pamela
P
Rosengarten
Department of Emergency Medicine, Women's and Children's Hospital, Adelaide, South Australia, Australia.
Amit
A
Kochar
Department of Emergency Medicine, Sunshine Hospital, Melbourne, Victoria, Australia.
David
D
Krieser
Department of Emergency Medicine, Children's Hospital, Sydney, New South Wales, Australia.
Sarah
S
Dalton
Children's Emergency Department, Starship Children's Hospital, Auckland, New Zealand.
Stuart
S
Dalziel
Middlemore Hospital, Auckland, New Zealand.|Department of Emergency Medicine, Kidz First Hospital, Auckland, New Zealand.
Jocelyn
J
Neutze
Department of Medical Imaging, Royal Children's Hospital, Melbourne, Victoria, Australia.
Tim
T
Cain
Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.
Kim
K
Jachno
Department of Emergency Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia.|Emergency Department, Royal Children's Hospital, Melbourne, Victoria, Australia.
Franz E
FE
Babl
D000293:Adolescent; D001315:Australia; D002648:Child; D002675:Child, Preschool; D006259:Craniocerebral Trauma / Q000175:diagnosis*; D004636:Emergency Service, Hospital / Q000458:organization & administration / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008485:Medical Audit; D010372:Pediatrics / Q000379:methods* / Q000706:statistics & numerical data; D016012:Poisson Distribution; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods / Q000706:statistics & numerical data*
computed tomography scan; head injury; paediatrics; radiation