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Evaluation of Head Injury in a Pediatric Emergency Department
Pretrauma and Posttrauma System
Jane M. Lavelle, MD;
Kathy N. Shaw, MD, MS
Arch Pediatr Adolesc Med. 1998;152:1220-1224.
Objective To determine if trauma center protocols affect the number of tests and consultations performed and the length of time spent in the emergency department or hospital.
Design A retrospective review and comparison of treatment for children with isolated head injury admitted to the emergency department before trauma center designation (group 1, 1985), and 5 years after implementation of trauma center protocols (group 2, 1991).
Setting Urban children's hospital, level I trauma center.
Results One hundred sixty-five children met the enrollment criteria in 1985 and 162 met the criteria in 1991. Falls were the predominant mechanism of injury (55%) for both years. For patients with moderate injury (Glasgow Coma Scale score, 9-12) or severe injury (Glasgow Coma Scale score, <9), there was no difference in radiographic or laboratory evaluation. For patients with minimal head injury (Glasgow Coma Scale score, 15, no loss of consciousness, amnesia, seizure, focal neurologic findings, or persistent symptoms) and minor head injury (Glasgow Coma Scale score, >12, and loss of consciousness or amnesia), more radiologic and laboratory studies were done in 1991 that showed no clinically significant abnormalities. Patients with minimal head injury in group 2 were 14 times more likely to have cranial computed tomographic scans performed (95% confidence interval [CI], 3.4-67); 11 times more likely to have cervical spine radiographs (95% CI, 2.2-76.6); and 23 times more likely to have hepatic enzymes obtained (95% CI, 3-491). These differences persisted when analyzed by both the age of the patient and mechanism of injury.
Conclusions Application of trauma system protocols to isolated head injury patient evaluation results in increased use of laboratory and radiologic services. These practices have the potential to increase the cost of medical care without significantly improving outcome.
From the Department of Pediatrics, University of Pennsylvania School of Medicine, Division of Emergency Medicine, the Children's Hospital of Philadelphia, Philadelphia, Pa.
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
Trauma Center Designation Increases Cost of Evaluating Pediatric Head Injury
JWatch Emergency Med. 1999;1999:16-16.
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