Imaging and admission practices in paediatric head injury across emergency departments in Australia and New Zealand: A PREDICT study

Natalie Phillips; Stuart R Dalziel; Meredith L Borland; Sarah Dalton; Mark D Lyttle; Silvia Bressan; Ed Oakley; Stephen Jc Hearps; Amit Kochar; Jeremy Furyk; John A Cheek; Yuri Gilhotra; Jocelyn Neutze; Franz E Babl; Paediatric Research in Emergency Department International Collaborative (PREDICT) group

doi:10.1111/1742-6723.13396

Imaging and admission practices in paediatric head injury across emergency departments in Australia and New Zealand: A PREDICT study

Emerg Med Australas. 2020 Apr;32(2):240-249. doi: 10.1111/1742-6723.13396. Epub 2019 Nov 26.

Authors

Natalie Phillips^{1

2}, Stuart R Dalziel^{3

4}, Meredith L Borland^{5

6}, Sarah Dalton⁷, Mark D Lyttle^{8

9

10}, Silvia Bressan^{8

11}, Ed Oakley^{8

12

13}, Stephen Jc Hearps⁸, Amit Kochar¹⁴, Jeremy Furyk¹⁵, John A Cheek^{8

12}, Yuri Gilhotra^{1

2}, Jocelyn Neutze¹⁶, Franz E Babl^{8

12

13}; Paediatric Research in Emergency Department International Collaborative (PREDICT) group

Affiliations

¹ Emergency Department, Queensland Children's Hospital, Brisbane, Queensland, Australia.
² Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia.
³ Emergency Department, Starship Children's Health, Auckland, New Zealand.
⁴ Liggins Institute, The University of Auckland, Auckland, New Zealand.
⁵ Emergency Department, Perth Children's Hospital, Perth, Western Australia, Australia.
⁶ Divisions of Paediatrics and Emergency Medicine, School of Medicine, The University of Western Australia, Perth, Western Australia, Australia.
⁷ Emergency Department, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.
⁸ Emergency Research Unit, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.
⁹ Emergency Department, Bristol Royal Hospital for Children, Bristol, UK.
¹⁰ Academic Department of Emergency Care, University of the West of England, Bristol, UK.
¹¹ Department of Women's and Children's Health, University of Padova, Padova, Italy.
¹² Emergency Department, The Royal Children's Hospital, Melbourne, Victoria, Australia.
¹³ Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia.
¹⁴ Emergency Department, Women's and Children's Hospital, Adelaide, South Australia, Australia.
¹⁵ Emergency Department, The Townsville Hospital, Townsville, Queensland, Australia.
¹⁶ Emergency Department, Kidz First Children's Hospital, Auckland, New Zealand.

PMID: 31773866
DOI: 10.1111/1742-6723.13396

Abstract

Objectives: Variation in the management of paediatric head injury has been identified worldwide. This prospective study describes imaging and admission practices of children presenting with head injury across 10 hospital EDs in Australia and New Zealand.

Methods: Prospective observational multicentre study of 20 137 children (under 18 years) as a planned secondary analysis of the Australasian Paediatric Head Injury Rules Study. All presentations with head injury without prior imaging were eligible for inclusion. Variations in rates of computed tomography of the brain (CTB) and admission practices between sites, ED type and country were investigated, as were clinically important traumatic brain injuries (ciTBIs) and abnormal CTBs within CTBs.

Results: Among the 20 137 enrolled patients, the site adjusted CTB rate was 11.2% (95% confidence interval [CI] 7.8-14.6); individual sites ranged from 2.6 to 18.6%. ciTBI was found in 0.4-2.2%, with abnormal scans documented in 0.7-6.5%. As a percentage of CTBs undertaken, ciTBIs were found in 12.8% (95% CI 10.8-14.7) with individual site variation of 8.8-16.9%, and no statistically significant difference noted, and traumatic abnormalities in 29.3% (95% CI 26.2-32.3) with individual site variation between 19.4 and 35.6%. Among those under 2 years,traumatic abnormalities were found in greater than 50% of CTBs at 90% of sites. Admission rate overall was 24.0% (site adjusted) with wide variation between sites (5.0-48.9%).

Conclusion: Across the 10 largely tertiary EDs included in this study, the overall CTB rate was low with no significant variation between sites when adjusted for ciTBIs.

Keywords: child; craniocerebral trauma; emergency service, hospital; tomography, X-ray computed.

Publication types

Multicenter Study
Observational Study
Research Support, Non-U.S. Gov't

MeSH terms

Australia / epidemiology
Child
Craniocerebral Trauma* / diagnosis
Craniocerebral Trauma* / epidemiology
Craniocerebral Trauma* / therapy
Emergency Service, Hospital
Humans
New Zealand / epidemiology
Prospective Studies
Tomography, X-Ray Computed*

Abstract

Publication types

MeSH terms

Grants and funding