Citation

Niele N, Willemars L, van Houten M, Plötz FB. Glob. Pediatr. Health 2019; 6: e2333794X19846117.

Affiliation

Tergooiziekenhuizen, Blaricum, Netherlands.

Copyright

(Copyright © 2019, SAGE Publishing)

DOI

10.1177/2333794X19846117

PMID

31065577

PMCID

PMC6487757

Abstract

It is estimated that every year about 12 000 children younger than 18 years of age are seen at an emergency department (ED) in the Netherlands with minor traumatic head injuries (MTHI).1 In the Netherlands, the national MTHI guidelines, published in 2010, decide whether or not to make a cranial computed tomography (CT) scan in children with MTHI.1 Briefly, based on the best available evidence at that time combined with personal experience, the expert committee concluded that it was safe and practical to distinguish 3 age categories.1 The age categories were classified as under the age of 2, between 2 and 5 years, and 6 years or more. In addition, per age category, various major and minor criteria were defined for obtaining a CT scan, which were primarily based on 2 pediatric studies, and added into a flowchart.2,3

It was expected that implementation of guidelines resulted in a more uniform management of pediatric MTHI and, as a result, decreased the number of CT scans in children with MTHI. However, a retrospective control study showed the opposite.4 Also, a recent prospective multicenter study among 1002 children in the northwest region of the Netherlands showed a high CT rate of 44%.5 This high CT use cannot be explained by increase of patient severity or increase rates of clinically important traumatic brain injuries.4,6,7 Several factors may contribute to CT scan increase. First, adherence to the Dutch MTHI guidelines is low.8 Second, the large amount of criteria in the guidelines and the fact that they could be interpreted in a number of ways resulted in large interhospital variations in the management of MTHI.9 Third, variations in obtaining CT scans also depend on the primarily responsible medical specialty in the ED.10 However, to date, it is unknown which medical specialties in the Netherlands are primarily responsible for the management of pediatric MTHI. In contrast to other countries, the EDs in the Netherlands are staffed by various medical specialties and not solely by pediatric emergency physicians. Furthermore, since the guidelines define 3 different age categories, it may be that even within one hospital different specialties are involved.

The objective of this national survey study was to determine which specialties are primarily responsible for the management of children with MTHI at the ED in the Netherlands. This may help understand differences in management of pediatric MTHI ...

Language: en