21 - UNDERSTANDING HEAD CT SCAN USAGE AMONGST ADOLESCENT BLUNT TRAUMA PATIENTS TREATED AT ADULT TRAUMA CENTERS

Objectives: Trauma is the leading cause of death among adolescents, accounting for approximately 40% of all causes of adolescent mortality. Computed tomography (CT) is considered the optimal imaging modality for assessing head trauma and is the most used imaging modality in the emergency department. Efforts to guide clinical decision-making when ordering head CTs exist, including guidelines by the Pediatric Emergency Care Applied Research Network (PECARN). Although guidelines are present, CTs are still being overutilized especially at adult trauma centers. The aim of our study was to review our use of head CTs in the adolescent blunt trauma patient population.

Methods: Patients aged 11-18 evaluated for blunt trauma who underwent head CT scans from 2016-2019 at our urban level 1 adult trauma center were included in this study. Patient demographics, head CT data, and PECARN head CT guideline criteria were collected via electronic medical records and analyzed through retrospective chart review. Analysis with fisher, chi-square, and ANOVA were utilized.

Results: Of the 285 patients requiring a head CT, 205 had negative head CT (NHCT) results and 80 patients had positive head CT (PHCT) results. There was no statistically significant difference in age, gender, race, and trauma mechanism between the NHCT and PHCT groups. However, the PHCT had a statistically significant higher Injury Severity Scale (ISS) compared to the NCHT (25 ± 13 vs 13±10; p < 0.01).
When comparing clinical characteristics, PHCT group was found to be with a statistically significant higher likelihood of having a Glasgow Coma Scale (GCS) < 15 (65% vs. 23%; p < 0.01), and abnormal head exam (70% vs. 25%; p < 0.01), suffered loss of consciousness (85% vs 54%; p < 0.01) compared to the NHCT group. By utilizing the PECARN criteria, we identified 44 patients with low risk for head injury yet still received a head CT. Of these 44 patients, none of the patients had a positive head CT. There were 111 patients found to be high risk of head injury and 57 (51%) were found to have a PHCT. Sixteen (20%) patients (14 high risk and 2 intermediate risk) with a PHCT required surgical intervention for their injury.

Conclusion: Our study suggests that reinforcement of the PECARN guidelines should occur for ordering head CTs in the adolescent blunt trauma patient population. Future prospective studies are needed to validate the use of PECARN head CT guideline in this patient population.