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A Specialized Pediatric Emergency Medicine Track Decreases Computed Tomography in Head Injured Patients

Conrad, Heather B. MD*†; Hollenbach, Kathryn A. PhD, MPH*†; Ratnayake, Kristin MD*†; Gehlbach, Daniel L. BS; Carstairs, Keri L. MD*†

Section Editor(s): Rutman, Lori E. MD, MPH; Associate Editor

doi: 10.1097/PEC.0000000000001870
Original Research-QI

Background There is an increased emphasis on reducing exposure to ionizing radiation in pediatric patients. Guidelines from the Pediatric Emergency Care Applied Research Network help practitioners identify patients at low risk for clinically important traumatic brain injury after head injury.

Objectives We seek to determine whether the institution of a pediatric track staffed by pediatric emergency medicine physicians (PEMs) within a community emergency department (ED) impacts the overall utilization of head computed tomography (CT) on children younger than 15 years with head injury.

Methods We used a retrospective cohort analysis of patients under the age of 15 years presenting to a community ED in the year before and the year of institution of a pediatric emergency track. Relative risk estimates were used to determine the risk of CT use associated with nonpediatric-trained emergency providers.

Results The community ED saw 11,094 patients and 14,639 patients younger than 15 years in fiscal years 2014–2015 and 2015–2016, respectively. In the year before PEMs, there were 312 children younger than 15 years seen for head injury; 47.09% received head CTs. After PEM coverage, there were 396 children younger than 15 years seen for head injury; 17.17% received head CTs. Pediatric patients with head injury were 2.2 times more likely to receive CTs before the institution of the pediatric track (95% confidence interval, 1.8–2.6).

Conclusion The implementation of a pediatric emergency track demonstrated a significant decrease in CT utilization for head injury. Continued development of pediatric tracks in community EDs can lead to reduction of CTs.

From the *Department of Pediatrics, University of California;

Department of Pediatrics, Rady Children's Hospital; and

San Diego State University, San Diego, CA.

Disclosure: The authors declare no conflict of interest.

Reprints: Heather B. Conrad, MD, Department of Pediatrics, Rady Children's Hospital, 3020 Children's Way, MC 5075, San Diego, CA 92123 (e-mail:

Online date: June 17, 2019

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