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Targeted head CT reduction for pediatric patients with hydrocephalus and traumatic brain injury: academic center institutional experience as an example of opportunities for further improvement

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Abstract

Purpose

Recent studies aim to reduce radiation exposure associated with computed tomography (CT) using rapid-sequence magnetic resonance imaging (MRI). We evaluated imaging modalities used for hydrocephalus and traumatic brain injury (TBI) to identify opportunities for further radiation exposure reduction.

Methods

Pediatric (≤ 18 years) patients, with either hydrocephalus or TBI receiving a head CT or head MRI from 2009 to 2017, were quantified using ICD9, ICD10, and CPT codes at a large university hospital. The odds ratios of receiving each imaging modality year-to-year and receiving a MRI or CT in a given year with each diagnosis were calculated.

Results

Beginning in 2015, hydrocephalus patients were more likely to receive a MRI vs CT (p < 0.0001), with likelihood increasing in the following 2 years. TBI patients were more likely to receive a CT than an MRI from 2009 to 2017. There was a smaller overall decrease in CT scans in TBI patients (p < 0.05) than hydrocephalus patients (p < 0.0001) and a larger increase in MRI use in hydrocephalus patients (p < 0.05) than TBI patients (p < 0.05) from 2009 to 2017.

Conclusions

Use of CT to evaluate hydrocephalus significantly decreased over the last 3-year time period. However, CT use for TBI patients was inconsistent and did not decrease proportionally, potentially representing a belief that CT is more effective than MRI for detecting hemorrhage. There was greater use of MRI as an alternate imaging method in hydrocephalus patients than TBI patients. Head injury remains an area of improvement to decrease pediatric radiation exposure at our institution and may be an area in need of attention more broadly.

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Acknowledgments

The authors would like to acknowledge Kathryn M. Pietrosimone, PhD, for editing this manuscript.

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Authors and Affiliations

  1. University of North Carolina School of Medicine, Chapel Hill, NC, USA

    Allie Harbert

  2. Department of Neurosurgery, University of North Carolina School of Medicine, Chapel Hill, NC, USA

    Weston Northam, Scott Elton & Carolyn Quinsey

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  1. Allie Harbert
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  2. Weston Northam
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  3. Scott Elton
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  4. Carolyn Quinsey
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Corresponding author

Correspondence to Carolyn Quinsey.

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This study was not considered human subject research and was exempt from IRB oversight by the UNC IRB.

Conflict of interest

This work was supported by the Carolina Medial Student Research Program. On behalf of all authors, the corresponding author states that there is no conflict of interest.

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Harbert, A., Northam, W., Elton, S. et al. Targeted head CT reduction for pediatric patients with hydrocephalus and traumatic brain injury: academic center institutional experience as an example of opportunities for further improvement. Childs Nerv Syst 36, 583–589 (2020). https://doi.org/10.1007/s00381-019-04376-w

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  • DOI: https://doi.org/10.1007/s00381-019-04376-w

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