Triggers for head computed tomography following paediatric head injury: Comparison of physicians' reported practice and clinical decision rules

Abstract

Objective: To compare head computed tomography (CT) triggers for paediatric head injury as reported by senior paediatric emergency physicians in Australia and New Zealand with triggers in published evidence-based clinical decision rules (CDRs).

Methods: A survey of CT triggers after head injury was distributed to senior emergency physicians at PREDICT (Paediatric Research in Emergency Departments International Collaborative) sites in Australia and New Zealand. Results were compared with recommendations for CT scans in CATCH, CHALICE and PECARN CDRs. Clinical practice guidelines (CPGs) from each site were also reviewed.

Results: The response rate was 93% (130/140). No published trigger for head CT was identified by 100% of survey participants and each CDR included several triggers not identified by many respondents. Abnormal examination findings, including depressed skull fracture and base of skull fracture, were most likely to prompt respondents to order a head CT (>90%). A concerning mechanism of injury, such as a fall greater than 3 feet or five stairs, triggered a CT response only in approximately 10% of respondents. Eight different head injury CPGs were used across the 13 PREDICT sites. These were highly variable between sites and CPGs were not explicitly based on published CDRs.

Conclusion: High-quality, published CDRs exist for head CT use after paediatric head injury. Physician-reported CT triggers differ from CDR-recommended triggers. The major published head injury CDRs should be prospectively validated in the Australasian setting before incorporating them into local practice and CPGs.