ArticlePediatrics2015
Quality Improvement Effort to Reduce Cranial CTs for Children With Minor Blunt Head Trauma.
Article in Pediatrics, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 35 papers, 3 of them syntheses that pooled it.
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
35 citing papers in PubMed, 3 syntheses or guidelines pooled it, 97 citations in OpenAlex.
- Disparities in computed tomography utilization for pediatric blunt trauma: a systematic review and meta-analysis comparing pediatric and non-pediatric trauma centers.Emergency radiology · 2023Pooled it
- Interventions to reduce low-value imaging - a systematic review of interventions and outcomes.BMC health services research · 2021Pooled it
- Scandinavian guidelines for initial management of minor and moderate head trauma in children.BMC medicine · 2016Guideline
- The Leaky Pipeline of Injury: Disparities at Multiple Junctures for Children with Head Trauma.The Journal of pediatrics · 2026Article
- Low-Value Emergency Care and Racial and Ethnic Differences Across US Children's Hospitals.Pediatrics · 2026Article
- Traumatic brain injuries in a district level emergency department in Cape Town: describing patients' journey from arrival to CT scan and neurosurgery.BMC emergency medicine · 2025Article
- Impact of a multi-modal intervention on CTA ordering rates in patients presenting with vertigo to the emergency department.Emergency radiology · 2025Article
- PECARN prediction rules for CT imaging of children presenting to the emergency department with blunt abdominal or minor head trauma: a multicentre prospective validation study.The Lancet. Child & adolescent health · 2024Article
- Computed Tomography Utilization in the Management of Children with Mild Head Trauma.Children (Basel, Switzerland) · 2023Article
- Improving Head CT Scan Decisions for Pediatric Minor Head Trauma in General Emergency Departments: A Pragmatic Implementation Study.Annals of emergency medicine · 2022Article
- The Clinical Utility of the Child SCAT5 for Acute Concussion Assessment.Sports medicine - open · 2022Article
- Computed Tomography Use in Children With Minor Head Trauma Presenting to 21 Community Emergency Departments Within an Integrated Health-Care System.The Permanente journal · 2021Article
- Low-Value Diagnostic Imaging in Children with Medicaid.The Journal of pediatrics · 2021Article
- Validation of the scandinavian guidelines for initial management of minor and moderate head trauma in children.European journal of trauma and emergency surgery : official publication of the European Trauma Society · 2021Article
- Use of Neuroimaging for Children With Seizure in General and Pediatric Emergency Departments.The Journal of emergency medicine · 2021Article
- Aligning Patient Safety and Stewardship: A Harm Reduction Strategy for Children.Current treatment options in pediatrics · 2021Review
- Missed intracranial injuries are rare in emergency departments using the PECARN head injury decision rules.Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery · 2021Article
- Indications for computed tomography use and frequency of traumatic abnormalities based on real-world data of 2405 pediatric patients with minor head trauma.Surgical neurology international · 2021Article
- Reduction of paediatric head CT utilisation at a rural general hospital emergency department.BMJ quality & safety · 2020Article
- Does implementation of the PECARN rules for minor head trauma improve patient-centered outcomes in a lower resource emergency department: a retrospective cohort study.BMC pediatrics · 2020Article
Corrections and comments
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Authors and funding
7 authors at 1 institution in 1 country.
Funding
Abstract
objectiveBlunt head trauma is a common injury in children, although it rarely requires surgical intervention. Cranial computed tomography (CT) is the reference standard for the diagnosis of traumatic brain injury but has been associated with increased lifetime malignancy risk. We implemented a multifaceted quality improvement initiative to decrease the use of cranial CT for children with minor head injuries.
methodsWe designed and implemented a quality improvement effort that included an evidence-based guideline as well as individual feedback for children aged 0 to 21 years who present to the emergency department (ED) for evaluation of minor blunt head trauma. Our primary outcome was cranial CT rate, and our balancing measure was any return to the ED within 72 hours that required hospitalization. We used statistical process control methodology to measure cranial CT rates over time.
resultsWe included 6851 ED visits of which 4242 (62%) occurred in the post-guideline implementation period. From a baseline CT rate of 21%, we observed an absolute reduction of 6% in cranial CT rate (95% confidence interval 3% to 9%) after initial guideline implementation and an additional absolute reduction of 6% (95% confidence interval 4% to 8%) after initiation of individual provider feedback. No children discharged from the ED required admission within 72 hours of initial evaluation.
conclusionsAn ED quality improvement effort that included an evidence-based guideline as well as individual provider feedback was associated with a reduction in cranial CT rates without an increase in missed significant head injuries.
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