Variation in utilization of computed tomography scanning for the investigation of minor head trauma in children: A Canadian experience

Objectives: To compare the utilization rates of CT scans in investigating m inor head trauma in children in Canada, to identify the injuries determined by these scans, and to identify clinical findings that are highly associat ed with its diagnosis and the injury itself. Methods: A retrospective cohor t study involving nine pediatric hospitals in Canada was conducted. A struc tured data collection method was used. Inclusion criteria included age 16 y ears or less, history of blunt head trauma, and a Glasgow Coma Scale score (GCS) greater than or equal to 13. Data collected included demographic info rmation, type of injury, relevant clinical information, computed tomography (CT) scan data, and clinical outcome. Clinical findings associated with CT scan and positive CT scan were identified using logistic regression. Resul ts: One thousand one hundred sixty-four children were included in the study . One hundred seventy-one (15%) had a CT scan, of which 60 (35%) were abnor mal. There was a significant difference in the rate of ordering of CT scans among the participating hospitals, but no significant difference in the ra te of abnormal CT scans. Mechanism of injury, GCS, and loss of consciousnes s were significantly related to the presence of an abnormal CT scan. Conclu sions: Although there is a significant difference in the utilization of CT scans to investigate minor head trauma in children across Canada, there is no significant difference in the frequency of head injuries in these patien ts. This suggests that it may be possible to determine clinical criteria th at are predictive of a head injury in these patients.