The Michigan College of Emergency Physicians (MCEP) Quality committee is launching a campaign to reduce computed tomography (CT) imaging of pediatric patients presenting to emergency departments with minor head trauma.  We have named this campaign “Mind MI Head,” and our goal is to educate parents, families, and physicians on when CT imaging is and is not indicated.

Pediatric head injury is a topic that has been extensively studied and reported in the medical literature. Kupperman et al. and the Pediatric Emergency Care Applied Research Network (PECARN) performed a study on patients <18 years of age presenting to 25 emergency departments within 24 hours of head trauma. In this landmark study, researchers created and validated highly accurate prediction rules for children at very low risk for clinically important traumatic brain injury and in whom CT scans should be avoided. This research was initially published in 2009 and subsequently verified in an external validation process in 2014, which supported the findings of the original study.

It is also well known that radiation from CT increases the life-time risk for radiation-associated cancer, such as leukemia, brain tumors, and thyroid cancer. Brenner et al. estimated that 1 in 1500 children exposed to head CT examination will go on to develop cancer, which is approximately 10 times higher than adult comparisons. As patient age decreases, the risk of cancer increases, with younger children being most at risk.

Despite this knowledge, the use of CT scans in the United States has increased at an alarming rate over the past 30 years, with an estimated 4-7 million CT scans performed on children each year. Thousands of children present or are referred to emergency departments annually for evaluation of minor head trauma. Parents and many physicians are often not aware of the PECARN predictive tool and/or risks associated with obtaining unnecessary CT scans. Furthermore, even when providers are aware, many do not use the PECARN decision rules to guide their pediatric imaging practices.

The goal of our campaign is to protect children from unnecessary radiation risks, provide education to both parents and the physician community within the state of Michigan regarding the appropriate use of head CT scans in children, and decrease resource utilization thereby ultimately lowering total cost of care.

This campaign is funded with a $10,000 Chapter Grant from the American College of Emergency Physicians.

The rollout of this campaign includes:

• The mailing of posters and badge buddies to all emergency departments and Urgent Care Centers in Michigan.
• A social and digital media campaign that will begin August 13 and run through September 30, including a 30 second video.
• A website dedicated to the campaign including the full length 2 minute 40 second video.
• Jointly publicized on the Michigan Department of Health and Human Services, MCEP, and MindMiHead.org website.

References:

Brenner, D, Elliston, C, Hall, E, Berdon, W. “Estimated Risks of Radiation-Induced Fatal Cancer from Pediatric CT.” AJR Am J Roentgenol 2001 Feb; 176(2): 289-96.

Kupperman, N, Holmes, J, Dayan, P, et al. “Identification of children at very low risk of clinically-important brain injuries after head trauma: a prospective cohort study.” Lancet 2009; 374: 1160-70

Mettler FA, Thomadsen BR, Bhargavan M, et al. “Medical radiation exposure in the U.S. in 2006: preliminary results”. Health Phys 2008; 95: 502–507

Schonfeld, D, Bressan, S, Da Dalt, L, et al. “Pediatric Emergency Care Applied Research Network head injury clinical prediction rules are reliable in practice.” Arch Dis Child 2014; 99: 427-431.

Strauss KJ, Goske MJ, Kaste SC, et al. “Image Gently: ten steps you can take to optimize image quality and lower CT dose for pediatric patients”. AJR Am J Roentgenol 2010; 194:868–873