Neuroimaging for Pediatric Head Trauma: Do Patient and Hospital Characteristics Influence Who Gets Imaged?
Neuroimaging for Pediatric Head Trauma: Do Patient and Hospital Characteristics Influence Who Gets Imaged?
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DOI：
10.1111/j.1553-2712.2010.00797.x
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发表时间：
2010-07-10
影响因子：
4.4
通讯作者：
Lee, Lois K.
中科院分区：
文献类型：
--
作者：
Mannix, Rebekah;Bourgeois, Florence T.;Lee, Lois K.
目的：目的是确定与使用神经影像学评估儿童头部创伤相关的患者、提供者和医院特征。方法：这是一项来自国家卫生统计中心收集的全国医院门诊医疗调查（NHAMCS）的头部损伤儿童（< 19岁）的横断面研究。NHAMCS收集了每年随机选择的600家医院急诊和门诊部约25,000次就诊的数据。这项研究调查了2002年至2006年间美国急诊科（EDs）的访问量。采用多变量logistic回归分析脑损伤儿童的神经影像学特征。结果：5年样本中有50,835例儿科就诊，其中1,256例（2.5%，95%可信区间[CI] = 2.2% ~ 2.7%）为头部损伤。其中39% （95% CI = 34% ~ 43%）接受了神经影像学评估。在多变量分析中,与神经影像学相关的因素包括白种人(比值比(或)= 1.5,95% CI = 1.02 - 2.1),老年(OR = 1.3, 95% CI = 1.1 - 1.5),表示一个综合医院(与儿科医院或= 2.4,95% CI = 1.1 - 5.3),更多的紧急分类地位(OR = 1.4, 95% CI = 1.1 - 1.8),承认或转让(OR = 2.7, 95% CI = 1.4 - 5.3),由主治医生和治疗(OR = 2.0, 95% CI = 1.1 - 3.7)。与综合医院相比，儿科医院种族的影响减弱（p < 0.001）。结论：在本研究中，患者种族、年龄和医院特异性特征与儿童闭合性颅脑损伤评估中的神经影像学检查频率相关。基于这些结果，关注综合医院医生的质量改进举措可能是降低儿童头部创伤后神经影像学率的有效方法。
P>Objectives:The objective was 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 (EDs) 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% confidence interval [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.