Neuroimaging for Pediatric Head Trauma: Do Patient and Hospital Characteristics Influence Who Gets Imaged?

Abstract

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.