{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,11]],"date-time":"2026-07-11T16:42:18Z","timestamp":1783788138314,"version":"3.55.0"},"reference-count":22,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2019,2,1]],"date-time":"2019-02-01T00:00:00Z","timestamp":1548979200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Academic Emergency Medicine"],"published-print":{"date-parts":[[2019,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>The purpose of this study was to determine if implementation of a Pediatric Emergency Care Applied Research Network (<jats:styled-content style=\"fixed-case\">PECARN<\/jats:styled-content>)\u2010based Closed Head Injury Assessment Tool could safely decrease computed tomography (<jats:styled-content style=\"fixed-case\">CT<\/jats:styled-content>) use for pediatric head injury evaluation at a nonpediatric community emergency department (<jats:styled-content style=\"fixed-case\">ED<\/jats:styled-content>).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A quality improvement project was initiated at a nonpediatric community <jats:styled-content style=\"fixed-case\">ED<\/jats:styled-content> to implement an institution\u2010specific, <jats:styled-content style=\"fixed-case\">PECARN<\/jats:styled-content>\u2010based Pediatric Closed Head Injury Assessment Tool. Baseline head <jats:styled-content style=\"fixed-case\">CT<\/jats:styled-content> use at the participating <jats:styled-content style=\"fixed-case\">ED<\/jats:styled-content> was determined for children with closed head injury through retrospective chart review from March 2014 through November 2015. Head injury patients were identified using International Classification of Disease (<jats:styled-content style=\"fixed-case\">ICD<\/jats:styled-content>)\u20109 codes for head injury, unspecified (959.01) and concussion with and without loss of consciousness (850\u2013850.9) until October 2015, after which <jats:styled-content style=\"fixed-case\">ICD<\/jats:styled-content>\u20109 was no longer used. To identify eligible patients after October 2015, lists of all pediatric patients evaluated at the participating <jats:styled-content style=\"fixed-case\">ED<\/jats:styled-content> were reviewed, and patients were included in the analysis if they had a physician\u2010assigned discharge diagnosis of head injury or concussion. Exclusion criteria were age \u2265 18 years, penetrating head trauma, history of brain tumor, ventriculoperitoneal shunt, bleeding disorder, or presentation\u00a0&gt;\u00a024 hours postinjury. Medical history, injury mechanism, symptoms, head <jats:styled-content style=\"fixed-case\">CT<\/jats:styled-content> use, and disposition were recorded. Implementation of the Pediatric Closed Head Injury Assessment Tool was achieved through provider education sessions beginning in December 2015 and ending in August 2016. Head <jats:styled-content style=\"fixed-case\">CT<\/jats:styled-content> use was monitored for 12 months postimplementation, from September 2016 through August 2017. Patients were classified into low, intermediate, or high risk for clinically important traumatic brain injury (ci<jats:styled-content style=\"fixed-case\">TBI<\/jats:styled-content>) by chart review. <jats:styled-content style=\"fixed-case\">ED<\/jats:styled-content> length of stay (<jats:styled-content style=\"fixed-case\">LOS<\/jats:styled-content>), disposition, and <jats:styled-content style=\"fixed-case\">ED<\/jats:styled-content> returns within 72 hours were recorded. Categorical variables were compared using chi\u2010square test or Fisher's exact test, and continuous variables, using Kruskal\u2010Wallis test.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 252 children with closed head injury were evaluated preimplementation (March 2014 through November 2015), 132 children were evaluated during implementation (December 2015 through August 2016), and 172 children were evaluated postimplementation (September 2016 through August 2017). Overall <jats:styled-content style=\"fixed-case\">CT<\/jats:styled-content> use decreased from 37.7% (95% confidence interval [<jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>]\u00a0= 31.7\u201343.7) preimplementation to 16.9% (95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>\u00a0= 11.3\u201322.5) postimplementation (p\u00a0&lt;\u00a00.001). Only 1% (95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>\u00a0= 0%\u20132.9%) of low\u2010risk patients received a head <jats:styled-content style=\"fixed-case\">CT<\/jats:styled-content> postimplementation compared to 22.6% (95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>\u00a0= 16.1%\u201329.1%) preimplementation (p\u00a0&lt;\u00a00.001). <jats:styled-content style=\"fixed-case\">CT<\/jats:styled-content> use among patients \u2265 24 months decreased from 42.9% (95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>\u00a0= 36.5%\u201349.6%) to 19.6% (95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>\u00a0= 13.1%\u201326.1%; p\u00a0&lt;\u00a00.001) and remained low and unchanged for patients\u00a0&lt;\u00a024 months. Transfers to a pediatric trauma center and <jats:styled-content style=\"fixed-case\">ED<\/jats:styled-content> returns within 72 hours were unchanged, while median <jats:styled-content style=\"fixed-case\">ED LOS<\/jats:styled-content> improved from 1.5 to 1.3 hours (p\u00a0=\u00a00.03). There were no missed ci<jats:styled-content style=\"fixed-case\">TBI<\/jats:styled-content>s after implementation of the guideline.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Implementation of the <jats:styled-content style=\"fixed-case\">PECARN<\/jats:styled-content>\u2010based Pediatric Closed Head Injury Assessment Tool reduced head <jats:styled-content style=\"fixed-case\">CT<\/jats:styled-content> use in a nonpediatric <jats:styled-content style=\"fixed-case\">ED<\/jats:styled-content>. The greatest impact was seen among children aged \u2265 24 months at very low risk for ci<jats:styled-content style=\"fixed-case\">TBI<\/jats:styled-content>.<\/jats:p><\/jats:sec>","DOI":"10.1111\/acem.13666","type":"journal-article","created":{"date-parts":[[2018,11,14]],"date-time":"2018-11-14T17:15:30Z","timestamp":1542215730000},"page":"784-795","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":31,"title":["Reduction of Computed Tomography Use for Pediatric Closed Head Injury Evaluation at a Nonpediatric Community Emergency Department"],"prefix":"10.1111","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8514-7762","authenticated-orcid":false,"given":"Melissa S.","family":"Puffenbarger","sequence":"first","affiliation":[{"name":"Mercy St. Louis Emergency Medicine St. Louis MO"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5919-6835","authenticated-orcid":false,"given":"Fahd A.","family":"Ahmad","sequence":"additional","affiliation":[{"name":"Department of Pediatrics St. Louis MO"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michelle","family":"Argent","sequence":"additional","affiliation":[{"name":"Center for Clinical Excellence St. Louis MO"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hongjie","family":"Gu","sequence":"additional","affiliation":[{"name":"Department of Biostatistics St. Louis MO"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3701-7327","authenticated-orcid":false,"given":"Charles","family":"Samson","sequence":"additional","affiliation":[{"name":"Department of Pediatrics St. Louis MO"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kimberly S.","family":"Quayle","sequence":"additional","affiliation":[{"name":"Washington University School of Medicine St. Louis MO"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9477-2436","authenticated-orcid":false,"given":"Jacqueline M.","family":"Saito","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery St. Louis MO"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2019,2]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.ss6609a1"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(09)61558-0"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2014-3588"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1553-2712.2012.01384.x"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00381-017-3577-9"},{"key":"e_1_2_8_7_1","first-page":"1","article-title":"National Hospital Ambulatory Medical Care Survey: 2007 Emergency department summary","volume":"26","author":"Niska R","year":"2010","journal-title":"Natl Health Stat Report"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1186\/1865-1380-6-13"},{"key":"e_1_2_8_9_1","unstructured":"RuiP KangK.National Hospital Ambulatory Medical Care Survey: 2015 Emergency Department Summary Tables. 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