Bustamante R; International Society of Technology Assessment in Health Care. Meeting.
Annu Meet Int Soc Technol Assess Health Care Int Soc Technol Assess Health Care Meet. 2002; 18: abstract no. 55.
Ministerio de salud, CHILE, heroes de la concepcion 502, Iquique, riccoord@hotmail.com
BACKGROUND/OBJECTIVES: To determine the clinical value and costs involved in plain skull radiography in pediatric patients with head trauma. METHODS: A restrospective review of records of all pediatric patients attending the emergency department at the largest hospital in Iquique, CHILE, with head trauma. RESULTS: 1730 patients were admitted carrying a history of head trauma, with a total of 2054 skull films done, whose cost was US%34,028. Severity score in these patients revealed 1494 (86.4%) mild; 80 (4.6%) medium severity; and 43 (2.5%) as severe. In all, 107 patients were admitted to the PICU, the remaining being dismissed to their homes either immediately after evaluation or having completed a brief observation period (1-2 hours) at the emergency ward. Of these admitted, 40 (37.4%) had skull radiographies showing fractures in different sites and extensions, head computed tomography scan had abnormal findings in 14 of them (0.8% of all the admissions to the emergency department). 851 (49%) patients were children less than two years old. Of them, 40 (6.5%) required admission to PICU. After a brief period of observation (average 2 days) they were discharged home. DISCUSSION: All the patients admitted to Pediatrics Intensive Care Unit were severe enough to require a prolongued observation period and a more specific treatment,the rest of them suffered head injury with minimal or no neurologic symptoms in which observation mainly at home with some guidelines to the parents when to seek medical assistance seems secure enough. If the evaluation at admission in the emergency department was to rely on an accurate clinical assessment, then 1494 patients, that accounted for 1773 skull films, weren't in need of them. If we consider a low threshold for radiographic imaging in children less than 2 years old as referred by many authors, we would still have 643 patients in which skull x-rays would have proven unnecessary. This means 763 x-rays films, saving US $12,640. Even though it is not a significant amount of money by itself, in a system like ours with a tight budget and often scarce to satisfy all different needs regarding health activities, adding this savings to others from areas were we could optimize our resources would enable us in guiding these activities more accurately, leaving the least of them unnattended or improperly fulfilled.
Publication Types:
Keywords:
- Child
- Child Abuse
- Chile
- Craniocerebral Trauma
- Emergencies
- Head
- Humans
- Observation
- Skull
- Skull Fractures
- X-Rays
- radiography
- hsrmtgs
Other ID:
UI: 102274671
From Meeting Abstracts