Background: Pediatric head trauma management varies between emergency departments globally. Here we aim\nto compare the pediatric minor head trauma management between a US and Italian hospital.\nMethods: We conducted a retrospective chart review of children 0-18 years old presenting after minor head\ntrauma (Glasgow Coma Scale 14-15) from two emergency departments, in Boston, Massachusetts, United States\nand Trieste, Italy, between January and December 2013. Frequencies of demographic, clinical, and management\ncharacteristic were calculated. We compared rate ratios for characteristics of patients receiving cranial computed\ntomography (CT) scans between the two populations.\nResults: There were 1783 patients in Boston, Massachusetts and 183 patients in Trieste, Italy. Patients in Boston\nhad more reported neurologic symptoms (61.2%) than in Trieste (6%) (p < 0.001). More CT scans were ordered\non the patients in Boston (17.3% vs. 6.6%) (p < 0.001), while more children were hospitalized in Trieste (55.7%\nvs. 8.6%) (p < 0.001). Patients with neurological symptoms more commonly had a CT scan in Trieste (45.5%)\nthan in Boston (23.5%) (RR 0.52, 95% CI 0.27, 1.00), while more patients without neurological symptoms had\nCTs in Boston (7.5%) than in Trieste (4.1%) (RR 1.85, 95% CI 0.86, 4.00). Assignment of triage levels and\ndefinitions of head injury severity varied considerably between the two hospitals, resulting in dissimilar\npopulations presenting to the two hospitals, and thus, differences in the management of these children.\nConclusion: The population of head trauma patients and the management of pediatric minor head trauma\ndiffers between Boston and Trieste, with a preference for CT scans in Boston and a preference for\nhospitalization in Trieste. Clinical guidelines used at each institution likely lead to this variation in care\ninfluenced by the different patient populations and institutional resources.
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