Variation in use of neuroimaging in the care of infants undergoing subspecialty evaluations for abuse: A multicenter study.

IF 3 3区 医学 Q1 PEDIATRICS
Emily Alpert, Joanne N Wood, Justine Shults, Daniel M Lindberg, Kristine A Campbell, Aashim Bhatia, James D Anderst, Angela Bachim, Rachel P Berger, Farah W Brink, Lori D Frasier, Nancy Harper, Natalie Laub, John Melville, Jan Leonard, M Katherine Henry
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引用次数: 0

Abstract

Objectives: (1) To quantify hospital-level variation in use of neuroimaging to screen for intracranial injury (ICI) among infants without overt signs or symptoms of head trauma undergoing subspecialty evaluations for physical abuse; (2) to assess for disproportionality in neuroimaging based on race/ethnicity and insurance type.

Methods: This was a cross-sectional study of infants age <12 months receiving subspecialty child abuse evaluations from 02/2021 - 12/2022 at 10 sites in CAPNET, a multicenter child abuse research network. Infants were included if they underwent a skeletal survey and lacked overt signs of possible ICI or blunt head injury. Outcome was completion of neuroimaging (computed tomography [CT] or magnetic resonance imaging [MRI]). Multivariable logistic regression was used to assess associations between demographic, clinical, and hospital factors with neuroimaging use.

Results: Of 1,114 infants, 746 (67%) underwent neuroimaging ranging from 51% to 80% across CAPNET hospitals. In multivariable analysis, young age, presence of rib fracture(s), and site had significant associations with neuroimaging. Insurance type and race/ethnicity did not contribute significantly to the model. After adjustment for case-mix, there was significant variation across hospitals, with neuroimaging use ranging from 51% (95% CI: 43%, 59%) to 79% (95% CI 71%, 88%) CONCLUSION: We identified significant variation in neuroimaging use across CAPNET hospitals, highlighting the need for guideline development and care standardization during the care of infants undergoing abuse evaluations.

在护理因虐待而接受亚专科评估的婴儿时使用神经影像学的差异:一项多中心研究。
目的:(1) 量化接受身体虐待亚专科评估的无明显头部外伤体征或症状的婴儿中使用神经影像学筛查颅内损伤(ICI)的医院水平差异;(2) 评估基于种族/民族和保险类型的神经影像学比例失调情况:这是一项针对婴儿年龄的横断面研究:在 1,114 名婴儿中,746 名(67%)接受了神经影像学检查,CAPNET 各家医院的比例从 51% 到 80% 不等。在多变量分析中,年龄小、肋骨骨折和部位与神经影像学检查有显著相关性。保险类型和种族/人种对模型的影响不大。结论:我们发现 CAPNET 各家医院在神经成像方面存在显著差异,这表明在对婴儿进行虐待评估时,需要制定相关指南并实现护理标准化。
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来源期刊
Academic Pediatrics
Academic Pediatrics PEDIATRICS-
CiteScore
4.60
自引率
12.90%
发文量
300
审稿时长
60 days
期刊介绍: Academic Pediatrics, the official journal of the Academic Pediatric Association, is a peer-reviewed publication whose purpose is to strengthen the research and educational base of academic general pediatrics. The journal provides leadership in pediatric education, research, patient care and advocacy. Content areas include pediatric education, emergency medicine, injury, abuse, behavioral pediatrics, holistic medicine, child health services and health policy,and the environment. The journal provides an active forum for the presentation of pediatric educational research in diverse settings, involving medical students, residents, fellows, and practicing professionals. The journal also emphasizes important research relating to the quality of child health care, health care policy, and the organization of child health services. It also includes systematic reviews of primary care interventions and important methodologic papers to aid research in child health and education.
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