• Daniel J Corwin, Dennis R Durbin, Katie L Hayes, and Mark R Zonfrillo.
• Office of Clinical Quality Improvement, The Children's Hospital of Philadelphia, Philadelphia, PA.
• Pediatr Emerg Care. 2021 Sep 1; 37 (9): 437441437-441.

ObjectiveThe aims of this study were to evaluate trends over time in computed tomography (CT) scan utilization after implementation of a clinical pathway in a tertiary care children's hospital emergency department (ED), to determine how ED throughput differs by CT utilization, and to determine provider reasoning for obtaining head CT in low-risk patients.MethodsThis was a retrospective cohort study of patients 21 years or younger discharged from our ED with head trauma (Glasgow Coma Scale score ≥13 and a head trauma International Classification of Diseases code) over a 5-year period, starting 1 year after pathway implementation (January 2012 to December 2016). A manual chart review of 10% of patients who received a CT was performed to determine reasoning for CT utilization and guideline compliance.ResultsIn total, 6.3% (95% confidence interval [CI], 5.9%-6.6%) of 21,129 discharged patients received a head CT, decreasing annually by an average of 0.9%. Pediatricians were more likely to obtain a CT than pediatric emergency medicine physicians after adjusting for acuity (odds ratio, 1.37; 95% CI, 1.02-1.82). Those who received a CT stayed 90 minutes longer (95% CI, 79-101 minutes) than those who did not after propensity score matching. Thirty percent of patients who received a CT in our manual chart review met low-risk Pediatric Emergency Care Applied Research Network criteria.ConclusionsHead CT rates in patients with minor head trauma consistently decreased each year after guideline implementation. Children who received head CT did not have prolonged lengths of stay compared with those who did not. A minority of patients who received a CT and were discharged met low-risk criteria by standardized guidelines.Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

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