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Schutzman, Sara

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Schutzman

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Sara

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Schutzman, Sara
Author's Publications: search.filters.isAuthorOfPublication.04f90a82-99a1-42f3-86b1-d3b7f77f4f89

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    Neuroimaging for Pediatric Head Trauma: Do Patient and Hospital Characteristics Influence Who Gets Imaged?
    (Wiley-Blackwell, 2010) Mannix, Rebekah; Bourgeois, Florence; Schutzman, Sara; Bernstein, Ari; Lee, Lois
    Objectives: To identify patient, provider, and hospital characteristics associated with the use of neuroimaging in the evaluation of head trauma in children. Methods: This was a cross-sectional study of children (≤19 years of age) with head injuries from the National Hospital Ambulatory Medical Care Survey (NHAMCS) collected by the National Center for Health Statistics. NHAMCS collects data on approximately 25,000 visits annually to 600 randomly selected hospital emergency and outpatient departments. This study examined visits to U.S. emergency departments between 2002 and 2006. Multivariable logistic regression was used to analyze characteristics associated with neuroimaging in children with head injuries. Results: There were 50,835 pediatric visits in the 5 year sample, of which 1,256 (2.5%, 95% CI = 2.2% to 2.7%) were for head injury. Among these, 39% (95% CI = 34% to 43%) underwent evaluation with neuroimaging. In multivariable analyses, factors associated with neuroimaging included white race (odds ratio [OR] 1.5, 95% CI = 1.02 to 2.1), older age (OR 1.3, 95% CI = 1.1 to 1.5), presentation to a general hospital (vs. a pediatric hospital, OR 2.4, 95% CI = 1.1 to 5.3), more emergent triage status (OR 1.4, 95% CI = 1.1 to 1.8), admission or transfer (OR 2.7, 95% CI = 1.4 to 5.3), and treatment by an attending physician (OR 2.0, 95% CI = 1.1 to 3.7). The effect of race was mitigated at the pediatric hospitals compared to at the general hospitals (p < 0.001). Conclusions: In this study, patient race, age, and hospital-specific characteristics were associated with the frequency of neuroimaging in the evaluation of children with closed head injuries. Based on these results, focusing quality improvement initiatives on physicians at general hospitals may be an effective approach to decreasing rates of neuroimaging after pediatric head trauma.
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    Factors Associated With the Use of Cervical Spine Computed Tomography Imaging in Pediatric Trauma Patients
    (Wiley-Blackwell, 2011) Mannix, Rebekah; Nigrovic, Lise E.; Schutzman, Sara; Hennelly, Kara; Bourgeois, Florence; Meehan, William P.; Fleisher, Gary; Monuteaux, Michael; Lee, Lois
    Objectives: To identify patient and hospital characteristics associated with the use of computed tomography (CT) imaging of the cervical spine (c-spine) in the evaluation of injured children and, in particular, to examine the influence of hospital setting. Methods: This was a retrospective cohort of children younger than 19 years of age from the Massachusetts Hospital Emergency Department (ED) database who were discharged from the ED with an injury diagnosis from 2005 through 2009. Multivariable logistic regression was used to analyze characteristics associated with CT imaging of the c-spine. Results: Of the 929,626 pediatric patients diagnosed with an injury in Massachusetts EDs and then discharged home, 1.3% underwent CT imaging of the c-spine. Rates of CT imaging nearly doubled over the five years. In the multivariable model, patient age (adjusted odds ratio [AOR] 2.3, 95% confidence interval [CI] = 2.0 to 2.7 for children age 12 to 18 years vs. under 1 year of age), and evaluation outside of a pediatric Level I trauma center (AOR 2.2, 95% CI = 1.1 to 4.3 for children evaluated at non Level I trauma centers vs. pediatric Level I trauma centers; AOR 2.1, 95% CI = 0.93 to 4.7 for children evaluated at adult Level I trauma centers vs. pediatric Level I trauma centers) were associated with higher rates of CT imaging of the c-spine. Conclusions: C-spine CT imaging for children discharged from the ED with trauma diagnoses increased from 2005 through 2009. Older age and evaluation outside a Level I pediatric trauma center were associated with a higher c-spine CT rate. Educational interventions focused outside pediatric trauma centers may be an effective approach to decreasing CT imaging of the c-spine of pediatric trauma patients.