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 provided 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 use is not without risks though, including those of sedation, and radiation induced cancer.

Several “rules” have been designed to guide doctors in the decision between risk of injury and risk of scan. The recently published Australasian APHIRST study examined three of these rules in our context. It found that all three rules performed well, clinicians made good judgements on who to scan, and the overall rate of CT scan use was low(10%). APHIRST was limited to 10 large metropolitan, and predominately children specific 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 A/Prof Franz Babl.

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


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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