Rate of Unnecessary CT-Scans and Related Factors in Pediatric Head Trauma

Abstract

Author(s): Mahyar Mohammadifard, Ashkan Mehrkish, Bita Bijari, Alireza Mirgholami, Abtin Ariyan

Introduction: Trauma is one of the most common reasons for patients to be referred to the emergency room, which is one of the most important diagnostic methods for trauma patients upon arrival. According to the many requests of doctors to perform CT scans of patients, the researchers consider the reasons for this to be the lack of clarity of the existing instructions or the lack of knowledge and concern of doctors regarding the mandatory cases of imaging. Regarding the lack of specific guidelines for obtaining CT scans in children in Birjand hospitals, the aim of this study was to investigate the rate of unnecessary CT scans and related factors in children with head trauma referred to the emergency department of Imam Reza Hospital. Materials and methods: In this cross-sectional study, 250 children with Trauma complaint were included in the study. After entering the emergency room and being examined by an emergency medicine specialist, the patients were referred to the radiology department for a brain CT scan if necessary. The CT scan taken from the patients was reviewed by the radiology assistant and the CT scan findings were recorded in the study checklist. Indications for CT scan were reviewed based on NEXUS II guideline. SPSS version 22 software was used. Chi-square statistical test was used to compare the differences. P value ≤0.05 was considered statistically significant. Results: The average age of children was 7.19 ± 3.38 years. The most common clinical symptom of children was headache. The most common indication based on the NEXUS II guideline was scalp hematoma followed by decreased consciousness. The most common CT scan finding was a fracture. 38.4% of the obtained CT scans were unnecessary. The frequency distribution of necessary CT scan did not differ significantly in terms of gender, age group of children and the symptoms of headache, nausea, vomiting, diplopia, raccoon sign and ettore (P>0.05), but the frequency distribution of necessary CT scan showed a significant difference in terms of Mechanism of trauma, GCS level, final outcome of patients, amnesia, battle sign and rhinorrhea (P<0.05). Conclusion: Based on the data presented herein, the rate of brain CT scans of children with unnecessary head trauma in Imam Reza Hospital was 38.4%. The frequency distribution of necessary CT scan showed significant differences from each other in terms of trauma mechanism, GCS level, patients' final outcome, amnesia, battle sign, rhinorrhea, neurological deficit, decreased consciousness, abnormal behavior and persistent nausea.

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