Clinical Practice Variability in Head CT Use for Pediatric Minor Head Injury

In 2009, the Pediatric Emergency Care Applied Research Network (PECARN) published prediction rules for children with blunt head trauma at very low risk for intracranial injury (NEJM JW Emerg Med Sep 25 2009). In a planned secondary analysis, investigators characterized the variability in use of cranial computed tomography (CT) among the 25 participating emergency departments.

Among more than 42,000 children enrolled between 2004 and 2006, CT use across institutions ranged from 19% to 69% — or from 15 to 112 scans per child with clinically important trauma brain injury, defined as head injury resulting in death, neurosurgery, endotracheal intubation for >24 hours, or hospital admission >2 nights. Rate of CT use was not associated with rates o…