Variation in Computed Tomography Use for Evaluation of XXXX in a Pediatric Emergency Department.

@entity1 @entity131 @entity174 @entity341 @entity542 @entity130
OBJECTIVES: Recent research has shown significant variation in rates of computed tomography (CT) use among pediatric hospital @entity341 ( @entity341 ) for evaluation of head injured @entity1 . We examined the rates of CT use by individual @entity341 attending physicians for evaluation of head injured @entity1 in a pediatric hospital @entity341 . METHODS: We used an administrative database to identify @entity1 younger than 18 years evaluated for @entity542 from January 2011 through March 2013 at our @entity1 's hospital @entity341 , staffed by pediatric emergency medicine (PEM) fellowship trained physicians and pediatricians. We excluded encounters with @entity130 team activation or previous head CT performed elsewhere. We excluded physicians whose @entity1 volume was less than 1 standard deviation below the group mean. RESULTS: After exclusions, we evaluated 5340 encounters for @entity542 by 27 @entity341 attending physicians. For individual physicians, CT rates ranged from 12.4% to 37.3%, with a mean group rate of 28.4%. Individual PEM physician CT rates ranged from 18.9% to 37.3%, versus 12.4% to 31.8% for pediatricians. Of the 1518 encounters in which CT was done, 128 (8.4%) had a @entity131 on CT, and 125 (8.2%) had a simple skull @entity174 without @entity131 on CT. @entity1 factors associated with CT use included age younger than 2 years, higher triage acuity, arrival time of 10:00 PM to 6:00 AM, hospital admission, and evaluation by a PEM physician. CONCLUSIONS: Physicians at our pediatric hospital @entity341 varied in the use of CT for the evaluation of head-injured @entity1 .
