Selecting children for head CT following head injury.
Arch Dis Child
; 101(10): 929-34, 2016 Oct.
Article
em En
| MEDLINE
| ID: mdl-27449674
ABSTRACT
OBJECTIVE:
Indicators for head CT scan defined by the 2007 National Institute for Health and Care Excellence (NICE) guidelines were analysed to identify CT uptake, influential variables and yield.DESIGN:
Cross-sectional study.SETTING:
Hospital inpatient units England, Wales, Northern Ireland and the Channel Islands. PATIENTS Children (<15â years) admitted to hospital for more than 4â h following a head injury (September 2009 to February 2010).INTERVENTIONS:
CT scan. MAIN OUTCOMEMEASURES:
Number of children who had CT, extent to which NICE guidelines were followed and diagnostic yield.RESULTS:
Data on 5700 children were returned by 90% of eligible hospitals, 84% of whom were admitted to a general hospital. CT scans were performed on 30.4% of children (1734), with a higher diagnostic yield in infants (56.5% (144/255)) than children aged 1 to 14â years (26.5% (391/1476)). Overall, only 40.4% (984 of 2437 children) fulfilling at least one of the four NICE criteria for CT actually underwent one. These children were much less likely to receive CT if admitted to a general hospital than to a specialist centre (OR 0.52 (95% CI 0.45 to 0.59)); there was considerable variation between healthcare regions. When indicated, children >3â years were much more likely to have CT than those <3â years (OR 2.35 (95% CI 2.08 to 2.65)).CONCLUSION:
Compliance with guidelines and diagnostic yield was variable across age groups, the type of hospital and region where children were admitted. With this pattern of clinical practice the risks of both missing intracranial injury and overuse of CT are considerable.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Tomografia Computadorizada por Raios X
/
Seleção de Pacientes
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Traumatismos Craniocerebrais
Tipo de estudo:
Clinical_trials
/
Etiology_studies
/
Guideline
/
Observational_studies
/
Prevalence_studies
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Prognostic_studies
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Risk_factors_studies
Limite:
Adolescent
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Child
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Child, preschool
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Humans
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Infant
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Newborn
País/Região como assunto:
Europa
Idioma:
En
Ano de publicação:
2016
Tipo de documento:
Article