Use of a mild traumatic brain injury guideline to reduce inpatient hospital imaging and charges

• Published in: Journal of pediatric surgery Vol. 46; no. 9; pp. 1777 - 1783
• Main Authors: Goldberg, Jillian, McClaine, Rebecca J, Cook, Becky, Garcia, Victor F, Brown, Rebeccah L, Crone, Kerry, Falcone, Richard A
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-09-2011
• Subjects: Adolescent; Brain Injuries - diagnostic imaging; Brain Injuries - economics; Charges; Child; Child, Preschool; Decision Trees; Guideline; Guideline Adherence; Head CT; Hospital Charges; Humans; Infant; Injury Severity Score; Inpatients; Length of stay; Pediatrics; Retrospective Studies; Surgery; Tomography, X-Ray Computed - economics; Tomography, X-Ray Computed - utilization; Guideline; Charges; Head CT; Length of stay
• ISSN: 0022-3468; 1531-5037
• DOI: 10.1016/j.jpedsurg.2011.02.052

Abstract Purpose In children, mild traumatic brain injuries (TBI) account for 70% to 90% of head injuries. Without clear guidelines, many of these children may be exposed to excess radiation owing to unnecessary imaging. The purpose of this study was to evaluate the impact of a mild TBI guideline in reducing hospital charges and repeated imaging of pediatric patients. Methods Charts of all children who had at least one head computed tomography and were admitted to our level 1 trauma center with a blunt TBI and Glasgow Coma Scale of 13 to 15 were retrospectively reviewed. Patients were divided into 2 groups relative to the implementation of a TBI management guideline. Results A total of 742 patients were included, 389 preguideline and 353 postguideline. Implementation of the guideline was associated with reductions in the average number of head computed tomographies performed (1.6 vs 1.3, P = .006), length of stay (2.3 vs 1.7 days, P < .0001), and overall hospital charges ($21,760 vs $13,980, P = .006). No children were readmitted for missed injuries. Conclusions Implementation of a simple guideline for the care of children with mild TBI can have significant impact on charges and length of stay while simultaneously reducing radiation exposure. Widespread implementation of such guidelines will improve efficiency without sacrificing quality of care in the management of mild TBI in the pediatric population.