Implementing an Evidence-Based Algorithm for CT in the Emergency Department
Published on: 2018-04-23
Objective: A substantial percentage of children who get CT scans after apparently minor head trauma, may not need them. Here we evaluate the impact of a quality improvement intervention on the appropriate use of head CT scanning in children presenting to the pediatric emergency department (ED).
Materials and Methods: Retrospective patient chart review to assess the impact of an intervention on adherence to an evidence-based algorithm for CT head scanning in a pediatric ED. Charts for all pediatric ED encounters for the pre-implementation period (August-September 2010) and the post-intervention period (November- December 2010). To identify variables associated with algorithm adherence we used a multivariate regression model.
Results: ED encounters were evaluated (n=346). Controlling for patient age, medical encounter reason, and health care provider type, odds of CT head scan algorithm adherence were 4.3x higher during the post-intervention time period (vs. pre-), p=0.0027. Odds of following the algorithm were lower for patients 2 years), p=0.0462. Medical encounter reason (trauma/non-trauma) and provider type were not associated with algorithm adherence.
Conclusion: A relatively simple, low-cost intervention resulted in an improvement in appropriate use of CT scans of the head, consistent with the evidence-based algorithm, in children presenting to the pediatric ED for traumatic or non-traumatic reasons.