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CT guidelines reduce risk and cost, improve satisfaction

Sunday, October 03, 2010

Following simple guidelines to determine when to perform follow-up CT scans on children admitted to the hospital with head injuries can lower risks, get kids home sooner, improve patient and family satisfaction and lower costs.

Those are among the findings of a study being presented today at the annual meeting of the American Academy of Pediatrics by a trauma specialist from Cincinnati Children’s Hospital Medical Center.

Richard Falcone, MD, MPH, director of Trauma Services at Cincinnati Children’s, said the guidelines to reduce imaging and hospital charges grew out concerns about overuse of the CT scans and delays in discharging patients leading to family frustration.

“Our institution, as well as almost all other institutions, likely over-image children during initial evaluations and subsequent care,” Dr. Falcone said. “There is an increased risk of cancer with imaging and therefore, less imaging is better.”

In addition to reducing the risk of cancer, less imaging also translates into fewer charges. And a shorter length of hospital stay when fewer CT scans are performed also reduces the cost of health care and improves patient and family satisfaction, Dr. Falcone and other researchers from Cincinnati Children’s found.

The retrospective study looked at 712 patients over four years admitted with mild traumatic brain injuries. The patients, ages birth to age 16, were seen in the emergency room for blunt head trauma. The guidelines were developed by trauma doctors and nurses, along with their peers in neurosurgery.

The guidelines categorized patients as high, low or normal risk following an initial head scan. When the guidelines for follow up scans were in place, researchers found a reduced number of scans, fewer overall hospitals and intensive care unit days, and lower charges (by about $8,000 per patient).

“Implementation of a relatively simple guideline helps guide and standardize the plan of care in children diagnosed with mild traumatic brain injury,” Dr. Falcone said. “Future and more widespread implementation of such guidelines can continue to improve overall care for injured children.”

About Cincinnati Children’s

Cincinnati Children’s Hospital Medical Center is one of just eight children’s hospitals named to the Honor Roll in U.S. News and World Report’s 2010-11 Best Children’s Hospitals. It is ranked #1 for digestive disorders and highly ranked for its expertise in pulmonology, cancer, neonatology, heart and heart surgery, neurology and neurosurgery, diabetes and endocrinology, orthopedics, kidney disorders and urology. Cincinnati Children’s is one of the top two recipients of pediatric research grants from the National Institutes of Health. It is internationally recognized for quality and transformation work by Leapfrog, The Joint Commission, the Institute for Healthcare Improvement, the federal Agency for Healthcare Research and Quality, and by hospitals and health organizations it works with globally. Additional information can be found at www.cincinnatichildrens.org.