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

Grant ID: EMPJ-375R27-2017

Project 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.


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



- Tavender, E.J., Wilson C.L., Dalziel, S.R., Oakley, E., Borland, M., Ballard, D.W., Cotterell, E., Phillips, N., Babl, F.E., 2022. Qualitative study of emergency clinicians to inform a national guideline on the management of children with mild-to-moderate head injuries. Emergency Medicine Journal. doi: 10.1136/emermed-2021-212198.

- Wilson, C.L., Hearps, S.J., Tavender, E.J., Phillips, N.T., Lawton, B., Kinnear, F., Beattie, A., Mitenko, H., Young, R., Cole, J. and Kochar, A., 2021. Factors predictive for computed tomography use and abnormality in paediatric head injuries in Australia and New Zealand. Emergency Medicine Australasia, 33(1), pp.157-160.

- Babl, F.E., Tavender, E., Ballard, D.W., Borland, M.L., Oakley, E., Cotterell, E., Halkidis, L., Goergen, S., Davis, G.A., Perry, D. and Anderson, V., 2021. Australian and New Zealand guideline for mild to moderate head injuries in children. Emergency medicine Australasia, 33(2), pp.214-231.

- Shavit, I., Rimon, A., Waisman, Y., Borland, M.L., Phillips, N., Kochar, A., Cheek, J.A., Gilhotra, Y., Furyk, J., Neutze, J. and Dalziel, S.R., 2020. Performance of two head injury decision rules evaluated on an external cohort of 18,913 children. Journal of surgical research, 245, pp.426-433.

- Kochar, A., Borland, M.L., Phillips, N., Dalton, S., Cheek, J.A., Furyk, J., Neutze, J., Lyttle, M.D., Hearps, S., Dalziel, S. and Bressan, S., 2020. Association of clinically important traumatic brain injury and Glasgow Coma Scale scores in children with head injury. Emergency medicine journal, 37(3), pp.127-134.

- Wilson, C.L., Tavender, E.J., Phillips, N.T., Hearps, S.J., Foster, K., O'Brien, S.L., Borland, M.L., Watkins, G.O., McLeod, L., Putland, M. and Priestley, S., 2020. Variation in CT use for paediatric head injuries across different types of emergency departments in Australia and New Zealand. Emergency Medicine Journal, 37(11), pp.686-689.


- Pediatric Academic Societies Meeting 2019 (PAS), Baltimore, USA. April 24-May 1 2019: Wilson CL, Tavender E, Phillips N, Oakley E, O’Brien S, Dalziel SR, Babl FE, for PREDICT. Variation in Head Computed Tomography Use for Paediatric Head Injury Across Different Types of Emergency Departments: Do We Have a Problem? (Poster)

- International Congress on Emergency Medicine (ICEM), Seoul, South Korea. 12-15 June 2019: Wilson CL, Tavender E, Phillips N, Oakley E, O’Brien S, Dalziel SR, Babl FE, for PREDICT.. Variation in Head Computed Tomography Use for Paediatric Head Injury Across Different Types of Emergency Departments: Do We Have a Problem? (Poster)

- ACEM ASM Hobart 2019: Head Injuries in Children: What Influences your Decision Making? Dr Emma Tavender & Cate Wilson


Amount Awarded


Grant Scheme


Principal Investigator:
Dr Natalie Phillips

Co Investigators:
A/Prof Franz Babl
Dr Shane George
Dr Benjamin Lawton
Dr Frances Kinnear
Dr Alex King
Dr Stephen Priestley
Dr Corey Cassidy
Dr Adam Michael

Associate Investigators:
Dr Emma Tavender
Ms Catherine Wilson
Dr Ali Crichton


Collaborating Institutions


  • PREDICT network study information
  • The APHIRST study
  • APHIRST media release (2017)

  • CONTACT US +61 7 3112 8668 Suite 1A 34 Sherwood Road Toowong, Qld 4066