Abstract
BACKGROUND: The Scandinavian Neurotrauma Committees (SNC) guideline is a validated and well established decision tool for pediatric minor to moderate head trauma in Sweden, categorizing patients into low, moderate and high risk for intracranial injury. It recommends observation over imaging with computer tomography in low and moderate risk stratified patients. However the effect on guideline implementation on emergency department length of stay and imaging rates with computer tomography is unknown. OBJECTIVE: Investigate the effects of the implementation of the SNC guidelines for pediatric minor head injury on utilization of computer tomography, emergency department length of stay and inhospital admission. METHODS: A retrospective observation study between January 2011 and December 2022 in a health care system in south east Sweden where SNCs guideline was implemented at the beginning of 2017. Computer tomography imaging rates, emergency department length of stay and hospital admission was compared for pediatric visits with a chief complaint of head injury made before the implementation of the SNCs guidelines in January 2017 was compared with visits made after the implementation using segmented time series analysis. RESULTS: A total of 16,244 visits pre-implementation were compared with 16,164 post-implementation. Death, neurosurgical intervention and intracranial hemorrhage was rare (< 0.1% for each outcome) and did not differ between the pre-implementation and post-implementation group. Computer tomography rates were 3.3% before and 2.7% after implementation.The time-series analysis showed that the majority of the reduction happened pre-implementation (14% yearly decrease) compared to post-implementation (1.6% yearly decrease). Emergency department length of stay did not differ at 89 (interquartile range 50-150) vs 91 (interquartile range 45-159) (p = 0.11) minutes respectively. Hospital admissions showed a continual decrease during the whole study period with little effect of the guideline implementation (13% vs 12% yearly decrease, p = 0.6). CONCLUSION: There were lower rates of computer tomography in pediatric patients with minor to moderate head trauma after the implementation of the SNCs guidelines but the majority of the reduction in imaging happened before the guideline implementation.