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Chhabra S, Cameron A, Thavorn K, Sikora L, Yadav K. Quality of health economic evaluations in emergency medicine journals: a systematic review. CAN J EMERG MED 2023; 25:676-688. [PMID: 37389770 DOI: 10.1007/s43678-023-00535-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 05/28/2023] [Indexed: 07/01/2023]
Abstract
OBJECTIVE Health economic evaluations are used in decision-making regarding resource allocation and it is imperative that they are completed with rigor. The primary objectives were to describe the characteristics and assess the quality of economic evaluations published in emergency medicine journals. METHODS Two reviewers independently searched 19 emergency medicine-specific journals via Medline and Embase from inception until March 3, 2022. Quality assessment was completed using the Quality of Health Economic Studies (QHES) tool, and the primary outcome was the QHES score out of 100. Additionally, we identified factors that may contribute to higher-quality publications. RESULTS 7260 unique articles yielded 48 economic evaluations that met inclusion criteria. Most studies were cost-utility analyses and of high quality, with a median QHES score of 84 (interquartile range, IQR: 72, 90). Studies based on mathematical models and those primarily designed as an economic evaluation were associated with higher quality scores. The most commonly missed QHES items were: (i) providing and justifying the perspective of the analysis, (ii) providing justification for the primary outcome, and (iii) selecting an outcome that was long enough to allow for relevant events to occur. CONCLUSIONS The majority of health economic evaluations in the emergency medicine literature are cost-utility analyses and are of high quality. Decision analytic models and studies primarily designed as economic analyses were positively correlated with higher quality. To improve study quality, future EM economic evaluations should justify the choice of the perspective of the analysis and the selection of the primary outcome.
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Affiliation(s)
- Shawn Chhabra
- Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada.
| | - Austin Cameron
- Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada
- Division of Neonatal-Perinatal Medicine, IWK Health Centre, Halifax, NS, Canada
| | - Kednapa Thavorn
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Lindsey Sikora
- Health Sciences Library, University of Ottawa, Ottawa, ON, Canada
| | - Krishan Yadav
- Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
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2
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Singh S, Hearps S, Nishijima DK, Cheek JA, Borland M, Dalziel S, Holmes J, Kuppermann N, Babl FE, Hoch JS. Cost-effectiveness of patient observation on cranial CT use with minor head trauma. Arch Dis Child 2022; 107:712-718. [PMID: 35193874 DOI: 10.1136/archdischild-2021-323701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 02/04/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To evaluate the cost-effectiveness of planned observation on cranial CT use in children with minor head trauma. DESIGN Planned secondary analysis of a multicentre prospective observation study. SETTING Australia and New Zealand. PATIENTS An analytic cohort of 18 471 children aged <18 years with Glasgow Coma Scale scores 14-15 presenting <24 hours after blunt head trauma stratified by the Pediatric Emergency Care Applied Research Network (PECARN) traumatic brain injury (TBI) risk categories. INTERVENTION A plan for observation and immediate CT scan were documented after the initial assessment. The planned observation group included those with planned observation and no immediate plan for CT. MAIN OUTCOME MEASURES Taking an Australian public-funded healthcare perspective, we estimated the cost-effectiveness of planned observation on the adjusted mean costs per child and CT use reduction by net benefit regression analysis using ordinary least squares with robust SEs and bootstrapping. All costs presented in 2018 euros. RESULTS Planned observation in 4945 (27%) children was cost-saving of €85 (95% CI -120 to -51) with 10.4% lower CT use (95% CI 9.6 to 11.2). This strategy was cost-saving for the PECARN high-risk (-€757 (95% CI -961 to -554)) and intermediate-risk (-€52 (95% CI -99 to -4.3)) categories, with 43% (95% CI 39 to 47) and 11% (95% CI 9.6 to 12.4) lower CT use, respectively. The very low-risk category incurred more cost of €86 (95% CI 67 to 104) with planned observation and 0.05% lower CT use (95% CI -0.61 to 0.71). CONCLUSION Planned ED observation in selected children with minor head trauma is cost-effective for reducing CT use for the PECARN intermediate-risk and high-risk categories. TRIAL REGISTRATION NUMBER ACTRN12614000463673.
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Affiliation(s)
- Sonia Singh
- Department of Paediatrics, The University of Melbourne Faculty of Medicine Dentistry and Health Sciences, Melbourne, Victoria, Australia .,Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Emergency Medicine, University of California Davis School of Medicine, Sacramento, California, USA
| | - Stephen Hearps
- Child Neuropsychology, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Daniel K Nishijima
- Department of Emergency Medicine, University of California Davis School of Medicine, Sacramento, California, USA
| | - John Alexander Cheek
- Department of Paediatrics, The University of Melbourne Faculty of Medicine Dentistry and Health Sciences, Melbourne, Victoria, Australia.,Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Emergency Department, Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
| | - Meredith Borland
- Emergency Medicine, Perth Children's Hospital, Nedlands, Western Australia, Australia.,Divisions of Paediatrics and Emergency Medicine, University of Western Australia, Crawley, Western Australia, Australia
| | - Stuart Dalziel
- Emergency Department, Starship Children's Health, Auckland, New Zealand.,Departments of Surgery and Paediatrics: Child and Youth Health, The University of Auckland, Auckland, New Zealand
| | - James Holmes
- Department of Emergency Medicine, University of California Davis School of Medicine, Sacramento, California, USA.,Center for Healthcare Policy and Research, University of California Davis Health System, Sacramento, California, USA
| | - Nathan Kuppermann
- Department of Emergency Medicine, University of California Davis School of Medicine, Sacramento, California, USA.,Department of Pediatrics, University of California Davis School of Medicine, Sacramento, California, USA
| | - Franz E Babl
- Department of Paediatrics, The University of Melbourne Faculty of Medicine Dentistry and Health Sciences, Melbourne, Victoria, Australia.,Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Emergency Department, Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
| | - Jeffrey S Hoch
- Center for Healthcare Policy and Research, University of California Davis Health System, Sacramento, California, USA.,Department of Public Health Sciences, University of California Davis, Davis, California, USA
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3
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Conombo B, Guertin JR, Tardif PA, Gagnon MA, Duval C, Archambault P, Berthelot S, Lauzier F, Turgeon AF, Stelfox HT, Chassé M, Hoch JS, Gabbe B, Champion H, Lecky F, Cameron P, Moore L. Economic Evaluation of In-Hospital Clinical Practices in Acute Injury Care: A Systematic Review. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2022; 25:844-854. [PMID: 35500953 DOI: 10.1016/j.jval.2021.10.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 08/27/2021] [Accepted: 10/31/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVES Underuse of high-value clinical practices and overuse of low-value practices are major sources of inefficiencies in modern healthcare systems. To achieve value-based care, guidelines and recommendations should target both underuse and overuse and be supported by evidence from economic evaluations. We aimed to conduct a systematic review of the economic value of in-hospital clinical practices in acute injury care to advance knowledge on value-based care in this patient population. METHODS Pairs of independent reviewers systematically searched MEDLINE, Embase, Web of Science, and Cochrane Central Register for full economic evaluations of in-hospital clinical practices in acute trauma care published from 2009 to 2019 (last updated on June 17, 2020). Results were converted into incremental net monetary benefit and were summarized with forest plots. The protocol was registered with PROSPERO (CRD42020164494). RESULTS Of 33 910 unique citations, 75 studies met our inclusion criteria. We identified 62 cost-utility, 8 cost-effectiveness, and 5 cost-minimization studies. Values of incremental net monetary benefit ranged from international dollars -467 000 to international dollars 194 000. Of 114 clinical interventions evaluated (vs comparators), 56 were cost-effective. We identified 15 cost-effective interventions in emergency medicine, 6 in critical care medicine, and 35 in orthopedic medicine. A total of 58 studies were classified as high quality and 17 as moderate quality. From studies with a high level of evidence (randomized controlled trials), 4 interventions were clearly dominant and 8 were dominated. CONCLUSIONS This research advances knowledge on value-based care for injury admissions. Results suggest that almost half of clinical interventions in acute injury care that have been studied may not be cost-effective.
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Affiliation(s)
- Blanchard Conombo
- Department of Social and Preventative Medicine, Université Laval, Québec City, Québec, Canada; Population Health and Optimal Health Practices Research Unit, Trauma - Emergency - Critical Care Medicine, Centre de Recherche du CHU de Québec (Hôpital de l'Enfant-Jésus), Université Laval, Québec City, Québec, Canada
| | - Jason R Guertin
- Department of Social and Preventative Medicine, Université Laval, Québec City, Québec, Canada
| | - Pier-Alexandre Tardif
- Population Health and Optimal Health Practices Research Unit, Trauma - Emergency - Critical Care Medicine, Centre de Recherche du CHU de Québec (Hôpital de l'Enfant-Jésus), Université Laval, Québec City, Québec, Canada
| | - Marc-Aurèle Gagnon
- Department of Social and Preventative Medicine, Université Laval, Québec City, Québec, Canada; Population Health and Optimal Health Practices Research Unit, Trauma - Emergency - Critical Care Medicine, Centre de Recherche du CHU de Québec (Hôpital de l'Enfant-Jésus), Université Laval, Québec City, Québec, Canada
| | - Cécile Duval
- Department of Social and Preventative Medicine, Université Laval, Québec City, Québec, Canada; Population Health and Optimal Health Practices Research Unit, Trauma - Emergency - Critical Care Medicine, Centre de Recherche du CHU de Québec (Hôpital de l'Enfant-Jésus), Université Laval, Québec City, Québec, Canada
| | - Patrick Archambault
- Department of Family Medicine and Emergency Medicine, Université Laval, Québec City, Québec, Canada; VITAM-Centre de recherche en santé durable, Université Laval, Québec City, Québec, Canada; Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Université Laval, Québec City, Québec, Canada
| | - Simon Berthelot
- Department of Family Medicine and Emergency Medicine, Université Laval, Québec City, Québec, Canada
| | - François Lauzier
- Division of Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Université Laval, Québec City, Québec, Canada
| | - Alexis F Turgeon
- Division of Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Université Laval, Québec City, Québec, Canada
| | - Henry T Stelfox
- Department of Critical Care Medicine, Medicine and Community Health Sciences, O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Michaël Chassé
- Department of Medicine, Université de Montréal, Québec City, Québec, Canada
| | - Jeffrey S Hoch
- Division of Health Policy and Management, Department of Public Health Sciences, University of California, Davis, Davis, CA, USA
| | - Belinda Gabbe
- School of Public Health and Preventive Medicine at Monash University, Melbourne, Victoria, Australia
| | - Howard Champion
- Uniformed Services University of the Health Sciences Annapolis, Bethesda, MD, USA
| | - Fiona Lecky
- School of Health and Related Research, Sheffield, England, UK
| | - Peter Cameron
- School of Public Health and Preventive Medicine at Monash University, Melbourne, Victoria, Australia
| | - Lynne Moore
- Department of Social and Preventative Medicine, Université Laval, Québec City, Québec, Canada; Population Health and Optimal Health Practices Research Unit, Trauma - Emergency - Critical Care Medicine, Centre de Recherche du CHU de Québec (Hôpital de l'Enfant-Jésus), Université Laval, Québec City, Québec, Canada.
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Singh S, Babl FE, Hearps SJC, Hoch JS, Dalziel K, Cheek JA. Trends of paediatric head injury and acute care costs in Australia. J Paediatr Child Health 2022; 58:274-280. [PMID: 34523175 DOI: 10.1111/jpc.15699] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 05/01/2021] [Accepted: 07/18/2021] [Indexed: 11/30/2022]
Abstract
AIM Paediatric head injuries (PHI) are the most common cause of trauma-related emergency department (ED) presentations. This study sought to report the incidence of PHI in Australia, examine the temporal trends from 2014 to 2018 and estimate the patient and population-level acute care costs. METHODS Taking a public-sector health-care perspective, we applied direct and indirect hospital costs for PHI-related ED visits and acute admissions. All costs were inflated to 2018 Australian dollars ($). The patient-level analysis was performed with data from 17 841 children <18 years old enrolled in the prospective Australasian Paediatric Head Injury Study. Mechanisms of injury were characterised by the total and average acute care costs. The population-level data of PHI-related ED presentations were obtained from the Independent Hospital Pricing Authority. Age-standardised incidence rates (IR) and incidence rate ratios (IRR) were calculated, and negative binomial regression examined the temporal trend. RESULTS The age-standardised IR for PHI was 2734 per 100 000 population in 2018, with a significant increase over 5 years (IRR 1.13, 95% confidence interval (CI) 1.12-1.14; P < 0.001) and acute care costs of $154 million. Falls occurred in 70% of the study cohort, with average costs per episode of $666 (95% CI: $627-$706), accounting for 47% of acute care costs. Transportation-related injuries occurred in 4.1% of the study cohort, with average costs per episode of $8555 (95% CI: $6193-$10 917), accounting for 35% of acute care costs. CONCLUSION PHI have increased significantly in Australia and are associated with substantial acute care costs. Population-based efforts are required for road safety and injury prevention.
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Affiliation(s)
- Sonia Singh
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia.,Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Emergency Medicine, University of California Davis Medical Center, Sacramento, California, United States
| | - Franz E Babl
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia.,Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Emergency Department, Royal Children's Hospital, Melbourne, Victoria, Australia
| | | | - Jeffrey S Hoch
- Center for Healthcare Policy and Research, University of California at Davis, Sacramento, California, United States.,Division of Health Policy and Management, Department of Public Health Sciences, University of California at Davis, Davis, California, United States
| | - Kim Dalziel
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Centre for Health Policy, The University of Melbourne School of Population and Global Health, Melbourne, Victoria, Australia
| | - John A Cheek
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia.,Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Emergency Department, Royal Children's Hospital, Melbourne, Victoria, Australia
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5
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Meral Atiş G, Altay T, Atiş ŞE. Comparison of CATCH, PECARN, and CHALICE clinical decision rules in pediatric patients with mild head trauma. Eur J Trauma Emerg Surg 2022; 48:3123-3130. [DOI: 10.1007/s00068-021-01859-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 12/11/2021] [Indexed: 11/03/2022]
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6
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Shih RY, Burns J, Ajam AA, Broder JS, Chakraborty S, Kendi AT, Lacy ME, Ledbetter LN, Lee RK, Liebeskind DS, Pollock JM, Prall JA, Ptak T, Raksin PB, Shaines MD, Tsiouris AJ, Utukuri PS, Wang LL, Corey AS. ACR Appropriateness Criteria® Head Trauma: 2021 Update. J Am Coll Radiol 2021; 18:S13-S36. [PMID: 33958108 DOI: 10.1016/j.jacr.2021.01.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 01/14/2021] [Indexed: 12/13/2022]
Abstract
Head trauma (ie, head injury) is a significant public health concern and is a leading cause of morbidity and mortality in children and young adults. Neuroimaging plays an important role in the management of head and brain injury, which can be separated into acute (0-7 days), subacute (<3 months), then chronic (>3 months) phases. Over 75% of acute head trauma is classified as mild, of which over 75% have a normal Glasgow Coma Scale score of 15, therefore clinical practice guidelines universally recommend selective CT scanning in this patient population, which is often based on clinical decision rules. While CT is considered the first-line imaging modality for suspected intracranial injury, MRI is useful when there are persistent neurologic deficits that remain unexplained after CT, especially in the subacute or chronic phase. Regardless of time frame, head trauma with suspected vascular injury or suspected cerebrospinal fluid leak should also be evaluated with CT angiography or thin-section CT imaging of the skull base, respectively. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
| | - Judah Burns
- Panel Chair, Montefiore Medical Center, Bronx, New York
| | | | - Joshua S Broder
- Duke University School of Medicine, Durham, North Carolina, American College of Emergency Physicians, Residency Program Director for Emergency Medicine, Vice Chief for Education, Division of Emergency Medicine, Department of Surgery, Duke University School of Medicine
| | - Santanu Chakraborty
- Ottawa Hospital Research Institute and the Department of Radiology, The University of Ottawa, Ottawa, Ontario, Canada, Canadian Association of Radiologists, CAR representative in ACR Quality Commission
| | - A Tuba Kendi
- Mayo Clinic, Rochester, Minnesota, Head of Nuclear Medicine Therapies at Mayo Clinic
| | - Mary E Lacy
- University of New Mexico, Albuquerque, New Mexico, American College of Physicians
| | | | - Ryan K Lee
- Einstein Healthcare Network, Philadelphia, Pennsylvania
| | - David S Liebeskind
- University of California Los Angeles, Los Angeles, California, American Academy of Neurology, President of SVIN
| | - Jeffrey M Pollock
- Oregon Health and Science University, Portland, Oregon, Editor, ACR Case in Point; Functional MRI Director, Oregon Health and Science University
| | - J Adair Prall
- Littleton Adventist Hospital, Littleton, Colorado, Neurosurgery expert, Chair, Guidelines Committee, Joint Section for Trauma and Critical Care
| | - Thomas Ptak
- R. Adams Cowley Shock Trauma Center, University of Maryland Medical Center, Baltimore, Maryland, Vice Chair of Community Radiology, University of Maryland Medical Center, Chief of Emergency and Trauma Imaging, R Adams Cowley Shock Trauma Center
| | - P B Raksin
- John H. Stroger Jr Hospital of Cook County, Chicago, Illinois, Neurosurgery expert, Chair Elect, American Association of Neurological Surgeons/Congress of Neurological Surgeons Section on Neurotrauma & Neurocritical Care; Vice Chair, American Association of Neurological Surgeons/Congress of Neurological Surgeons Joint Guidelines Review Committee; Director, Neurosurgery ICU
| | - Matthew D Shaines
- Albert Einstein College of Medicine Montefiore Medical Center, Bronx, New York, Internal Medicine Physician, Associate Program Director for the Moses-Weiler Internal Medicine Residency Program, Albert Einstein College of Medicine; Associate Chief, Division of Hospital Medicine
| | | | | | - Lily L Wang
- University of Cincinnati Medical Center, Cincinnati, Ohio, Neuroradiology Fellowship Program Director
| | - Amanda S Corey
- Specialty Chair, Atlanta VA Health Care System and Emory University, Atlanta, Georgia
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Furtado LMF, da Costa Val Filho JA, Dos Santos AR, E Sá RF, Sandes BL, Hon Y, Dos Santos Júnior EC, Faleiro RM. Pediatric minor head trauma in Brazil and external validation of PECARN rules with a cost-effectiveness analysis. Brain Inj 2020; 34:1467-1471. [PMID: 32791018 DOI: 10.1080/02699052.2020.1802667] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Pediatric minor head trauma approaches aim to ensure the absence of traumatic brain lesions, minimize ionizing radiation, and enhance cost control. We evaluated the applicability and cost-effectiveness of the Pediatric Emergency Care Applied Research Network (PECARN) rules after head trauma and rationalize the use of head computed tomography (CT) scans. METHODS We retrospectively divided patients <18 years old who presented at a single institution in Brazil with minor head trauma into four groups: Group I (skull X-ray only), Group II (head CT only), Group III (X-ray and CT), and Group IV (observation only). Direct costs were calculated based on examination and length of hospitalization. The PECARN rules were applied retrospectively in each patient to determine who required a CT scan, and the costs were re-calculated. RESULTS Of the 1328 patients, CT scans were performed in 36.4% and X-rays in 52.6%. The mean cost was USD 5.88, 34.58, 41.85, and 4.04 for Groups I-IV, respectively. After applying the PECARN rules, 77.6% of patients no longer required a CT scan, and overall costs were reduced from USD 16.71 to 7.88 (p < .001). Conclusion: The PECARN rules demonstrated a meaningful cost-effectiveness and should be applied to the Brazilian pediatric population.
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Affiliation(s)
- Leopoldo Mandic Ferreira Furtado
- Department of Pediatric Neurosurgery, Vila Da Serra Hospital , Nova Lima, Brazil.,Department of Neurosurgery, João XXIII Hospital, FHEMIG, Belo Horizonte , Minas Gerais, Brazil
| | | | | | | | - Bruno Lacerda Sandes
- Residents of Neurosurgery at Department of Pediatric Neurosurgery, Vila da Serra Hospital and Biocor Institute , Nova Lima, Brazil
| | - Yangpol Hon
- Residents of Neurosurgery at Department of Pediatric Neurosurgery, Vila da Serra Hospital and Biocor Institute , Nova Lima, Brazil
| | | | - Rodrigo Moreira Faleiro
- Department of Neurosurgery, João XXIII Hospital, FHEMIG, Belo Horizonte , Minas Gerais, Brazil
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8
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Babl FE, Dalziel SR, Borland ML. Establishing a research network. J Paediatr Child Health 2020; 56:857-863. [PMID: 32364324 DOI: 10.1111/jpc.14896] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 04/06/2020] [Indexed: 11/26/2022]
Abstract
Multicentre research provides advantages over single-centre research by maximising available patient numbers while pooling varied expertise and resources available across different participating investigators and sites. The increased complexity of multicentre regulatory approvals, communication and study management, can be mitigated by the formation of a research network where multicentre efforts move from ad hoc, single projects to formalised ongoing collaboration. Network research helps prioritise research efforts and importantly fosters the development of a collaborative track record in terms of research expertise, research capacity and grant success. It also has the potential to rapidly change patient care across many hospitals as research results will be more generalizable and definitive. This paper sets out the key elements of network research, its benefits and possible challenges drawing on the example of PREDICT (Paediatric Research in Emergency Departments International Collaborative) an established paediatric emergency research network in Australia and New Zealand.
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Affiliation(s)
- Franz E Babl
- Emergency Department, Royal Children's Hospital, Melbourne, Victoria, Australia.,Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia.,PREDICT Paediatric Research in Emergency Departments International Collaborative, Melbourne, Australia
| | - Stuart R Dalziel
- Emergency Department, Starship Children's Hospital, Auckland, New Zealand.,Department of Surgery, University of Auckland, Auckland, New Zealand.,Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand
| | - Meredith L Borland
- Emergency Department, Perth Children's Hospital, Perth, Western Australia, Australia.,Divisions of Paediatrics and Emergency Medicine, School of Medicine, University of Western Australia, Perth, Western Australia, Australia
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9
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Niele N, van Houten M, Tromp E, van Goudoever J, Plötz FB. Application of PECARN rules would significantly decrease CT rates in a Dutch cohort of children with minor traumatic head injuries. Eur J Pediatr 2020; 179:1597-1602. [PMID: 32342189 PMCID: PMC7479012 DOI: 10.1007/s00431-020-03649-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 03/25/2020] [Accepted: 04/08/2020] [Indexed: 01/16/2023]
Abstract
The aim of this study was to determine the potential impact of the Pediatric Emergency Care Applied Research Network (PECARN) rules on the CT rate in a large paediatric minor traumatic head injury (MTHI) cohort and compare this with current national Dutch guidelines. This was a planned sub-study of a prospective multicentre observational study that enrolled 1006 children younger than 18 years with MTHI. We calculated the number of recommended CT scans and described trauma-related CT scan abnormalities. The PECARN rules recommended a significantly lower percentage of CT scans in all age categories, namely 101/357 (28.3%) versus 164/357 (45.9%) (p < 0.001) in patients under 2 years of age and 148/623 (23.8%) versus 394/623 (63.2%) (p < 0,001) versus in patients 2 years and older.Conclusion: The projected CT rate can significantly be reduced if the PECARN rules are applied. We therefore advocate that the PECARN guidelines are also implemented in The Netherlands. What is Known: • To guide clinicians whether to perform a CT scan in children with a minor traumatic head injury (MTHI) clinical decision rules has been developed. • The overall CT scan rate in adherence with the Dutch MTHI guidelines is 44%. What is New: • The projected CT rate can significantly be reduced in a Dutch cohort of MTHI if the PECARN rules are applied. • The Dutch national guidelines for MTHI can safely be replaced by the PECARN rules.
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Affiliation(s)
- Nicky Niele
- Department of Paediatrics, Tergooi Hospital, Rijksstraatweg1, 1261 AN Blaricum, The Netherlands
- Department of Paediatrics, Amsterdam UMC, Emma Children’s Hospital,, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Ellen Tromp
- Department of Epidemiology and Statistics, St Antonius Hospital, Nieuwegein, The Netherlands
| | - J.B. van Goudoever
- Department of Paediatrics, Amsterdam UMC, Emma Children’s Hospital,, University of Amsterdam, Amsterdam, The Netherlands
| | - Frans B. Plötz
- Department of Paediatrics, Tergooi Hospital, Rijksstraatweg1, 1261 AN Blaricum, The Netherlands
- Department of Paediatrics, Amsterdam UMC, Emma Children’s Hospital,, University of Amsterdam, Amsterdam, The Netherlands
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10
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Mower WR. Improving Patient Selection for Pediatric Computed Tomographic Head Imaging. Ann Emerg Med 2019; 74:820-821. [DOI: 10.1016/j.annemergmed.2019.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Indexed: 10/25/2022]
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11
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Nigrovic LE, Kuppermann N. Children With Minor Blunt Head Trauma Presenting to the Emergency Department. Pediatrics 2019; 144:peds.2019-1495. [PMID: 31771961 DOI: 10.1542/peds.2019-1495] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/10/2019] [Indexed: 11/24/2022] Open
Abstract
In our state-of-the-art review, we summarize the best-available evidence for the optimal emergency department management of children with minor blunt head trauma. Minor blunt head trauma in children is a common reason for emergency department evaluation, although clinically important traumatic brain injuries (TBIs) as a result are uncommon. Cranial computed tomography (CT) scanning is the reference standard for the diagnosis of TBIs, although they should be used judiciously because of the risk of lethal malignancy from ionizing radiation exposure, with the greatest risk to the youngest children. Available TBI prediction rules can assist with CT decision-making by identifying patients at either low risk for TBI, for whom CT scans may safely be obviated, or at high risk, for whom CT scans may be indicated. For clinical prediction rules to change practice, however, they require active implementation. Observation before CT decision-making in selected patients may further reduce CT rates without missing children with clinically important TBIs. Future work is also needed to incorporate patient and family preferences into these decision-making algorithms when the course of action is not clear.
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Affiliation(s)
- Lise E Nigrovic
- Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts; and
| | - Nathan Kuppermann
- Departments of Emergency Medicine and.,Pediatrics, School of Medicine, University of California, Davis, Davis, California; and.,UC Davis Health, Sacramento, California
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12
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Babl FE, Cheek J, Dalziel K, Bressan S, Dalziel SR. In reply. Ann Emerg Med 2019; 74:821-823. [PMID: 31779958 DOI: 10.1016/j.annemergmed.2019.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Indexed: 11/25/2022]
Affiliation(s)
- Franz E Babl
- Royal Children's Hospital, Melbourne, Victoria, Australia; Murdoch Children's Research Institute, Melbourne, Victoria, Australia; Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - John Cheek
- Royal Children's Hospital, Melbourne, Victoria, Australia; Murdoch Children's Research Institute, Melbourne, Victoria, Australia; Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Kim Dalziel
- Health Economics Group, Center for Health Policy, University of Melbourne, Melbourne, Victoria, Australia
| | - Silvia Bressan
- Department of Women's and Children's Health, University of Padova, Padova, Italy
| | - Stuart R Dalziel
- Emergency Department, Starship Children's Health, Auckland, New Zealand; Liggins Institute, University of Auckland, Auckland, New Zealand
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13
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Niele N, Houten MA, Boersma B, Biezeveld MH, Douma M, Heitink K, ten Tusscher GW, Tromp E, van Goudoever JB, Plötz FB. Multi-centre study found that strict adherence to guidelines led to computed tomography scans being overused in children with minor head injuries. Acta Paediatr 2019; 108:1695-1703. [PMID: 30721540 DOI: 10.1111/apa.14742] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 01/28/2019] [Accepted: 02/01/2019] [Indexed: 12/01/2022]
Abstract
AIM Our primary aim was to calculate the head computed tomography (CT) scan rate in children with a minor head injury (MHI) when the Dutch National guidelines were followed in clinical practice. The secondary aim was to determine the incidence of CT abnormalities and the guideline predictors associated with traumatic abnormalities. METHODS We performed a multi-centre, prospective observational cross-sectional study in the emergency departments of six hospitals in The Netherlands between 1 April 2015 and 31 December 2016. RESULTS Data on 1002 patients were studied and 69% of cases complied with the guidelines. The overall CT rate was 44% and the incidence of traumatic abnormal CT findings was 13%. CT scans were performed in 19% of children under two years of age, 48% of children between two and five years and 63% of children aged six years or more. Multivariate regression analysis for all age categories showed that CT abnormalities were predicted by a Glasgow Coma Scale of less than 15, suspicion of a basal skull fracture, vomiting and scalp haematomas or external lesions of the skull. CONCLUSION Strict adherence to the Dutch national guidelines resulted in CT overuse. New guidelines are needed to safely reduce CT scan indications.
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Affiliation(s)
- Nicky Niele
- Department of Paediatrics Tergooi Hospital Blaricum The Netherlands
- Department of Paediatrics Emma Children's Hospital Amsterdam UMC Amsterdam The Netherlands
| | - Marlies A. Houten
- Department of Paediatrics Spaarne Gasthuis Hospital Hoofddorp The Netherlands
| | - Bart Boersma
- Department of Paediatrics Noordwest Ziekenhuisgroep Alkmaar The Netherlands
| | | | - Matthijs Douma
- Department of Emergency Medicine Dijklander Hospital Hoorn The Netherlands
| | - Katja Heitink
- Department of Paediatrics Flevo Hospital Almere The Netherlands
| | | | - Ellen Tromp
- Department of Epidemiology and Statistics St Antonius Hospital Nieuwegein The Netherlands
| | | | - Frans B. Plötz
- Department of Paediatrics Tergooi Hospital Blaricum The Netherlands
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14
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Singh S, Cheek JA, Babl FE, Hoch JS. Review article: A primer for clinical researchers in the emergency department: Part X. Understanding economic evaluation alongside emergency medicine research. Emerg Med Australas 2019; 31:710-714. [PMID: 31237083 DOI: 10.1111/1742-6723.13320] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 04/25/2019] [Accepted: 04/25/2019] [Indexed: 11/30/2022]
Abstract
In this series we address research topics in emergency medicine. While traditionally there was an almost exclusive focus on the efficacy and effectiveness of interventions in emergency research, analysis of the costs and the societal impact of different approaches and pathways have become increasingly important. In this paper we will address what health economics means and discuss the different types and key features of economic evaluation relevant for clinical researchers.
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Affiliation(s)
- Sonia Singh
- Emergency Research, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia.,Paediatric Research in Emergency Departments International Collaborative (PREDICT), Melbourne, Victoria, Australia.,Department of Emergency Medicine, University of California Davis Medical Center, Sacramento, California, USA
| | - John A Cheek
- Emergency Research, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia.,Paediatric Research in Emergency Departments International Collaborative (PREDICT), Melbourne, Victoria, Australia.,Emergency Department, Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Franz E Babl
- Emergency Research, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia.,Paediatric Research in Emergency Departments International Collaborative (PREDICT), Melbourne, Victoria, Australia.,Emergency Department, Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Jeffrey S Hoch
- Center for Heathcare Policy and Research, University of California at Davis, Sacramento, California, USA.,Division of Health Policy and Management, Department of Public Health Sciences, University of California at Davis, Davis, California, USA
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15
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Khalifa M, Gallego B. Grading and assessment of clinical predictive tools for paediatric head injury: a new evidence-based approach. BMC Emerg Med 2019; 19:35. [PMID: 31200643 PMCID: PMC6570950 DOI: 10.1186/s12873-019-0249-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 06/03/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Many clinical predictive tools have been developed to diagnose traumatic brain injury among children and guide the use of computed tomography in the emergency department. It is not always feasible to compare tools due to the diversity of their development methodologies, clinical variables, target populations, and predictive performances. The objectives of this study are to grade and assess paediatric head injury predictive tools, using a new evidence-based approach, and to provide emergency clinicians with standardised objective information on predictive tools to support their search for and selection of effective tools. METHODS Paediatric head injury predictive tools were identified through a focused review of literature. Based on the critical appraisal of published evidence about predictive performance, usability, potential effect, and post-implementation impact, tools were evaluated using a new framework for grading and assessment of predictive tools (GRASP). A comprehensive analysis was conducted to explain why certain tools were more successful. RESULTS Fourteen tools were identified and evaluated. The highest-grade tool is PECARN; the only tool evaluated in post-implementation impact studies. PECARN and CHALICE were evaluated for their potential effect on healthcare, while the remaining 12 tools were only evaluated for predictive performance. Three tools; CATCH, NEXUS II, and Palchak, were externally validated. Three tools; Haydel, Atabaki, and Buchanich, were only internally validated. The remaining six tools; Da Dalt, Greenes, Klemetti, Quayle, Dietrich, and Güzel did not show sufficient internal validity for use in clinical practice. CONCLUSIONS The GRASP framework provides clinicians with a high-level, evidence-based, comprehensive, yet simple and feasible approach to grade, compare, and select effective predictive tools. Comparing the three main tools which were assigned the highest grades; PECARN, CHALICE and CATCH, to the remaining 11, we find that the quality of tools' development studies, the experience and credibility of their authors, and the support by well-funded research programs were correlated with the tools' evidence-based assigned grades, and were more influential, than the sole high predictive performance, on the wide acceptance and successful implementation of the tools. Tools' simplicity and feasibility, in terms of resources needed, technical requirements, and training, are also crucial factors for their success.
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Affiliation(s)
- Mohamed Khalifa
- Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, 75 Talavera Road, North Ryde, Sydney, NSW, 2113, Australia.
| | - Blanca Gallego
- Centre for Big Data Research in Health, Faculty of Medicine, University of New South Wales, Lowy Cancer Research Centre, Level 4, Cnr High &, Botany St, Kensington, Sydney, NSW, 2052, Australia
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