Reducing Head CT Use for Children With Head Injuries in a Community Emergency Department
Reducing Head CT Use for Children With Head Injuries in a Community Emergency Department
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DOI：
10.1542/peds.2016-1349
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发表时间：
2017-04-01
期刊：
影响因子：
8
通讯作者：
Tieder, Joel S.
中科院分区：
文献类型：
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作者：
Jennings, Rebecca M.;Burtner, Jennifer J.;Tieder, Joel S.
背景与目的：临床决策规则减少了使用计算机断层扫描（CT）来评估儿科急诊科（ED）中的轻微儿科头部损伤。CT在社区急诊室的使用率仍然很高，大多数儿童在社区急诊室寻求医疗护理。我们试图减少率的CT扫描用于评估儿童头部损伤从29%到20%in a community艾德.METHODS：我们评估了一个质量改进（QI）项目在社区艾德旨在减少使用头部CT扫描的儿童通过实施一个有效的头部创伤预测规则创伤性脑损伤。一个多学科团队确定了CT使用的关键驱动因素，并实施了决策辅助工具，以改善预测规则的使用。团队识别并消除了障碍。一家附属儿童医院为参与者提供了认证学分的维护和QI辅导。我们使用统计过程控制图来评估干预对每月CT扫描率的影响，并进行Wald等效性检验来比较干预前和干预后CT扫描的比例。结果：基线期（2013年2月至2014年7月）包括695例患者，CT扫描率为29.2%（95%置信区间，25.8%-32.6%）。干预后阶段（2014年8月至2015年10月）包括651例患者，CT扫描率为17.4%（95%置信区间，14.5%-20.2%，P
BACKGROUND AND OBJECTIVE: Clinical decision rules have reduced use of computed tomography (CT) to evaluate minor pediatric head injury in pediatric emergency departments (EDs). CT use remains high in community EDs, where the majority of children seek medical care. We sought to reduce the rate of CT scans used to evaluate pediatric head injury from 29% to 20% in a community ED.METHODS: We evaluated a quality improvement (QI) project in a community ED aimed at decreasing the use of head CT scans in children by implementing a validated head trauma prediction rule for traumatic brain injury. A multidisciplinary team identified key drivers of CT use and implemented decision aids to improve the use of prediction rules. The team identified and mitigated barriers. An affiliated children's hospital offered Maintenance of Certification credit and QI coaching to participants. We used statistical process control charts to evaluate the effect of the intervention on monthly CT scan rates and performed a Wald test of equivalence to compare preintervention and postintervention CT scan proportions.RESULTS: The baseline period (February 2013-July 2014) included 695 patients with a CT scan rate of 29.2% (95% confidence interval, 25.8%32.6%). The postintervention period (August 2014-October 2015) included 651 patients with a CT scan rate of 17.4% (95% confidence interval, 14.5%-20.2%, P