Assessing Children’s Head Injury: Variation in CT scan use (APHIRST-Gap)

Grant ID: EMPJ-375R27-2017

Lay Summary

This study will collect information from the records of 3000 children from 30 hospitals presenting after a head injury in 2016 and will interview staff to look at different factors influencing the care provided. APHIRST-Gap is expected to provide crucial information on scan rates and inform strategies, including national guideline development to standardise and improve the care of children with head injury across Australia and New Zealand.

Head injury is a common reason children present to Emergency Departments in Australia and New Zealand. While most are minor the important issue for emergency clinicians is to determine whether a particular child is at risk of a serious head injury such as a bleed on the brain. A computerised tomography(CT) scan is the investigation of choice to look for these injuries. Its presents risks though, including the risk of sedation, and radiation induced cancer.

Several “rules” have been designed to guide doctors in the decision, by weighing up the risk of injury with the risks associated with the scan. The published Australasian APHIRST study examined three of these rules. It found that all three rules performed well, clinicians made sound judgements, and the overall rate of CT scan use was low (10%). APHIRST was limited to 10 large metropolitan, and predominately paediatric hospitals. Most children in Australia are not seen in these hospitals. Further research is required to determine whether there is a large variation in scan use between different hospitals and how best to apply these findings to a broader range of hospitals.

This trial is being run by the PREDICT network and the Principal Investigator is Prof Franz Babl.


Outcomes

A quantitative study of 2472 eligible presentations from 25 EDs analysed found that neuroimaging rates for paediatric head injury in Australia and New Zealand are not higher in mixed urban/suburban or regional/rural EDs when compared with tertiary paediatric EDs. Assessing variation in CTB (CT brain scan) rates across hospital types is an important consideration in strategies to improve care.

Results of this EMF-funded research contributed to the PREDICT Network’s subsequent success in obtaining an NHMRC Centre of Research Excellence in Paediatric Emergency Medicine, led by Professor Franz Babl. A national head injury guideline is also currently in development as an outcome of this study. This project also led to the establishment of new collaborative research relationships between the QCH (Queensland Children’s Hospital, formerly named Lady Cilento Children's Hospital) and other sites, including several that are new to paediatric collaborative ED research on this scale.


Leveraged Funds

- NHMRC Centre for Research Excellence Grant (ID: 1058560): $90,000
- Centre for Community Child Health - 'Advancing Knowledge Translation and Research Impact': $20,000


Dissemination

Shavit I., Rimmon A., Borland M.L., Phillips N., Kochar A., Cheek J.A. Gilhotra S.Y., Furyk F., Neutze J., Dalziel S.R., Lyttle M.D., Bressan S., Donath S., Hearps S., Oakley E., Crowe L., Babl F.E., the Paediatric Research in Emergency Departments International Collaborative (PREDICT), "Performance of Two Head Injury Decision Rules Evaluated on an External Cohort of 18,913 Children", Journal of Surgical Research, Jan 2020; 245:426-433. doi: 10.1016/j.jss.2019.07.090


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