{"pk":19365,"title":"Variation in Specialists’ Reported Hospitalization Practices of Children Sustaining Blunt Head Trauma","subtitle":null,"abstract":"Introduction: Questions surround the appropriate emergency department (ED) disposition of children who have sustained blunt head trauma (BHT). Our objective was to identify physician disposition preferences of children with blunt head trauma (BHT) and varying computed tomography (CT) findings.\nMethods: We surveyed pediatric and general emergency physicians (EP), pediatric neurosurgeons (PNSurg), general neurosurgeons (GNSurg), pediatric surgeons (PSurg) and trauma surgeons regarding care of two hypothetical patients: Case 1: a 9-year-old who fell 10 feet and Case 2: an 11-month-old who fell 5 feet.  We presented various CT findings and asked physicians about disposition preferences. We evaluated predictors of patient discharge using multivariable regression analysis adjusting for hospital and ED characteristics and clinician experience. Pediatric EPs served as the reference group.\nResults: Of 2,341 eligible surveyed, 715 (31%) responded. Most would discharge children with linear skull fractures (Case 1, 71%; Case 2, 62%). Neurosurgeons were more likely to discharge children with small subarachnoid hemorrhages (Case 1 PNSurg OR 6.87, 95% CI 3.60, 13.10; GNSurg OR 6.54, 95% CI 2.38, 17.98; Case 2 PNSurg OR 5.38, 95% CI 2.64, 10.99; GNSurg OR 6.07, 95% CI 2.08, 17.76). PSurg were least likely to discharge children with any CT finding, even linear skull fractures (Case 1 OR 0.14, 95% CI 0.08, 0.23; Case 2 OR 0.18, 95% CI 0.11, 0.30). Few respondents (<6%) would discharge children with small intraventricular, subdural, or epidural bleeds.\nConclusion: Substantial variation exists between specialties in reported hospitalization practices of neurologically-normal children with BHT and traumatic CT findings. [West J Emerg Med. 2013;14(1):29-36.]","language":"en","license":{"name":"Creative Commons Attribution-NonCommercial  4.0","short_name":"CC BY-NC 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNonCommercial — You may not use the material for commercial purposes.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by-nc/4.0"},"keywords":[{"word":"blunt head trauma"},{"word":"pediatric"},{"word":"Hospitalization"},{"word":"Emergency Medicine"},{"word":"pediatrics"}],"section":"Practice Variability","is_remote":true,"remote_url":"https://escholarship.org/uc/item/2b4313b7","frozenauthors":[{"first_name":"Cheryl","middle_name":"W","last_name":"Vance","name_suffix":"","institution":"University of California Davis, Department of Pediatrics, Davis, California; University of California Davis, Department of Emergency Medicine, Davis, California","department":"None"},{"first_name":"Moon","middle_name":"O","last_name":"Lee","name_suffix":"","institution":"University of California Davis, Department of Emergency Medicine, Davis, California","department":"None"},{"first_name":"James","middle_name":"F","last_name":"Holmes","name_suffix":"","institution":"University of California Davis, Department of Emergency Medicine, Davis, California","department":"None"},{"first_name":"Peter","middle_name":"E","last_name":"Sokolove","name_suffix":"","institution":"University of California Davis, Department of Emergency Medicine, Davis, California","department":"None"},{"first_name":"Michael","middle_name":"J","last_name":"Palchak","name_suffix":"","institution":"University of California Davis, Department of Emergency Medicine, Davis, California","department":"None"},{"first_name":"Beth","middle_name":"A","last_name":"Morris","name_suffix":"","institution":"University of California Davis, Department of Emergency Medicine, Davis, California","department":"None"},{"first_name":"Nathan","middle_name":"","last_name":"Kuppermann","name_suffix":"","institution":"University of California Davis, Department of Emergency Medicine, Davis, California","department":"None"}],"date_submitted":"2011-10-22T15:57:40Z","date_accepted":"2011-10-22T15:57:40Z","date_published":"2012-11-17T07:26:17Z","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/19365/galley/9578/download/"}]}