In head CT for kids, less is more

Cincinnati Children's Hospital has demonstrated an ability to reduce the use of CT scans in kids with traumatic brain injury, which reduces costs, shortens length of stay, cuts radiation exposure and associated cancer risk. From AuntMinnie (Head CT frequency, costs drop for kids after rule change):

"We got them out of the hospital faster, reduced their radiation dose and therefore their cancer risk, and saved money all at the same time while making the parents happier and less frustrated -- and, most importantly, not missing any injuries or not having any kids come back because we didn't scan them," [Prinicipal Investigator Dr. Richard] Falcone said.

The change affected kids with traumatic brain injury who received a first CT scan and then were admitted to the hospital. Under the new guideline, kids with a rating of 13 to 15 on the Glasgow coma scale were allowed to skip the second scan. Before implementation of the guideline, average length of stay was 2.3 days with 1.6 CT scans and $24,000 of hospital charges. Post-guideline implementation length of stay dropped to 1.7 days, CT scans went down to 1.3 and charges fell to $14,000.

"We got them out of the hospital faster, reduced their radiation dose and therefore their cancer risk, and saved money all at the same time while making the parents happier and less frustrated -- and, most importantly, not missing any injuries or not having any kids come back because we didn't scan them," Falcone said."It raises the question, at least, that maybe there can be still fewer scans and we can reduce them even further," he said. "It's really a small minority of kids that need this repeat scan, and our feeling is that there's still maybe too many kids getting a scan."

The US health care system generally works against these sorts of changes. Fewer scans often mean less revenue for the provider organization, doctors order extra scans as part of defensive medicine --or so we're told-- and the ideologues would call this rationing. Yet we need these sort of changes for the health care system to survive and thrive. Let's hope that evidence based medicine, comparative effectiveness research, patient safety, and accountability all increase. If so we can expect to see more improvements like this one.