Pop-up assessment reduces unnecessary use of head CTs in pediatric trauma settings

An alert system that provides clinical decision support tools was recently shown to reduce the use of unnecessary imaging on pediatric patients in emergency departments. 

The work is detailed in the Annals of Emergency Medicine, in which experts share how they were able to create a pop-up alert system that provided a risk assessment to help clinicians determine whether the use of a computed tomography scan is necessary to rule out traumatic brain injury in children. The system included Pediatric Emergency Care Applied Research Network (PECARN) head trauma clinical decision rules in the risk assessment, and after its implementation the experts found that clinicians became more adherent to these guidelines. 

“The risk of clinically important TBI (ciTBI) in pediatric patients with minor head trauma is less than 1%, yet, cranial computed tomography (CT) use remains a common practice,” corresponding author Andrew J. Knighton, PhD, of Intermountain Healthcare in Salt Lake City, Utah, and co-authors wrote. “Although CT scans in high-risk groups are a necessary diagnostic tool, CT scans in the low-risk groups yield little diagnostic benefit and expose children to unnecessary radiation.” 

The study included 12,670 pediatric minor head trauma encounters treated by 339 clinicians at 21 urban and rural general ED sites in an integrated health care system. Between July 2018 and December 2020 clinicians were presented with the intervention, which appeared on their screens at the point when imaging decisions were typically made. The effectiveness of the system was measured in terms of guideline adherence, CT scan rate and 72-hour readmissions with clinically important traumatic brain injury.