Background Blunt head injury is a common pediatric injury and often evaluated in general emergency departments. It estimated that 50% of children will undergo a head computed tomography (CT), often unnecessarily exposing the child to ionizing radiation. Pediatric academic centers have shown quality improvement (QI) measures can reduce head CT rates within their emergency departments. We aimed to reduce head CT utilization at a rural community emergency department.
Methods Children presenting with a complaint of blunt head injury and were evaluated with or without a head CT. Head CT rate was the primary outcome. We developed a series of interventions and presented these to the general emergency department over the duration of the study. The pre and intervention data was analysed with control charts.
Results The preintervention and intervention groups consisted of 576 children: 237 patients with a median age of 8.0 years and 339 patients with a median age of 9.00 years (p=0.54), respectively. The preintervention HCT rate was 41.8% (95% CI 35.6% to 48.1%) and the postintervention rate was 27.7% (95% CI 23.3% to 32.7%), a decrease of 14.1% (95% CI 6.2% to 21.9%, p=0.0004). During the intervention period, there was a decrease in HCT rate of one per month (OR 0.96, 95% CI 0.92 to 1.00, p=0.07). The initial series of interventions demonstrated an incremental decrease in HCT rates corresponding with a special cause variation.
Conclusion The series of interventions dispersed over the intervention period was an effective methodology and successfully reduced HCT utilisation among children with blunt head injury at a rural community emergency department.
- Continuous quality improvement
- Control charts, run charts
- Emergency department
- Healthcare quality improvement
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Contributors JPL conceived and designed the study, was involved in acquisition of data, analysis and interpretation of data, drafting of the manuscript, critical revision of the manuscript for important intellectual content, and study supervision. JA helped design the study, was involved with the drafting of the manuscript, provided administrative and technical support, and study supervision. TN-T and HN-T were involved with acquisition of data, analysis and interpretation of data, and drafting of the manuscript. RS was involved with analysis and interpretation of data and statistical expertise. TH was involved with study design, acquisition of data and drafting the manuscript. RAF was involved with study design, drafting the manuscript, critical revision of the manuscript for important intellectual content and study supervision.
Funding The research reported in this publication was supported by the National Center for Advancing Translational Sciences of the National Institutes of Health (award number UL1-TR002494).
Disclaimer The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Competing interests None declared.
Patient consent for publication Not required.
Ethics approval The study was approved by the university’s institutional review board.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement Data are available upon reasonable request. Deidentified data will be made available after all ongoing analyses are completed. Requesters will be required to sign a Letter of Agreement detailing the mechanisms by which the data will be kept secure and access restricted to their study team. The agreements will also state the recipient will not attempt to identify any individual whose data are included and will not share the data with anyone outside of their research team. The data set will not include PHI (Protected Health Information) and all dates removed.
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