H. Naseem1, A. Train1, S. Baek2, T. Zhuang3, K. Bass1,4 1Women And Children’s Hospital Of Buffalo,Department Of Pediatric Surgery,Buffalo, NY, USA 2State University Of New York At Buffalo,Department Of Urban And Regional Planning, School Of Architecture And Planning,Buffalo, NY, USA 3State University Of New York At Buffalo,Department Of Biostatistics,Buffalo, NY, USA 4State University Of New York At Buffalo,Department Of Surgery, Jacobs School Of Medicine And Biomedical Sciences,Buffalo, NY, USA
Introduction: Trauma systems encourage expedited transfer of patients requiring specialty trauma services. Initial management and use of imaging is variable among hospital types. Our purpose was to compare the use of head computed tomography (CT) by hospital type for management of pediatric head injury in our region. Our hypothesis is that community hospitals have a higher rate of head CT's for evaluation of pediatric head trauma compared to a Pediatric Trauma Center (PTC).
Methods: Retrospective study using the state discharge database including patients <18 years old presenting with a diagnosis of head injury from January 2010 to December 2014. Exclusions were incomplete data, hospitals with <10 patients and disposition of death or left against medical advice. The exposure variable of interest was hospital type and main outcome variable of interest was head CT scan. Secondary exposure variable was age and secondary outcome variable was disposition. A p-value of <0.05 was considered significant.
Results: A total of 22,129 patients were included in analysis of which 52% received a head CT. 32% of patients were evaluated at a PTC, 2% at an adult trauma center (ATC), 25% at an adult community hospital (ACH), 33% at an adult/pediatric community hospital (APCH), and 8% at an urgent care center (UC). On univariate analysis, patients presenting with a head injury to the PTC were more likely to receive a head CT in their evaluation than patients presenting to an ACH, APCH, ATC, or UC (p<0.0001). Patients between ages 4-13 (OR: 1.629, 95% CI: 1.525 to 1.741) and 14-17 (OR: 2.917, 95% CI: 2.718 to 3.131) were more likely to receive a head CT compared to patients who were 0-3 years old (Table 1). On multivariate analysis, patients with a head CT were more likely to be admitted (OR: 1.929, 95% CI: 1.668 to 2.230) as well as transferred from the community hospital to the PTC (OR: 2.320, 95% CI: 1.891 to 2.847).
Conclusion: Community hospitals are evaluating the majority of pediatric head injuries in our region without exceeding the rate of head CT utilization at the PTC. Patients receiving a head CT are more likely to be admitted or transferred to a PTC, suggesting that the head CT is not being used as a primary screening tool. Patients evaluated for head injury in our region are more likely to receive a head CT and undergo admission when presenting to the PTC compared to an ATC, ACH, APCH or UC. Further outcomes research is needed to delineate appropriate utilization of head CT based on current standards.
