The impact of the Scandinavian Neurotrauma Committee guidelines for pediatric head trauma on the management in the Emergency Department - a retrospective time series analysis

Background The Scandinavian Neurotrauma Committees (SNC) guideline is a validated and well-established decision tool for pediatric mild 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 hospital admission Methods A retrospective observation study between January 2011 and December 2022 in a health care system in southeast Sweden where SNCs guideline was implemented at the end of 2016. 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 16244 pre-implementation visits were compared with 16164 post-implementation visits. Computer tomography rates were 3.3% before and 2.7% after, but the time-series analysis showed that the reduction happened during pre-implementation (14% yearly decrease) compared to post-implementation (1.6% yearly decrease). The 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 mild to moderate head trauma after the implementation of the SNCs guidelines, but the reduction in imaging happened before the guideline implementation.