CONTEXT Reducing unnecessary imaging in emergency departments (EDs) for children with minor traumatic brain injuries (mTBIs) has been encouraged. OBJECTIVE Our objective was to systematically review the effectiveness of interventions to decrease imaging in this population. DATA SOURCES Eight electronic databases and the gray literature were searched. STUDY SELECTION Comparative studies assessing ED interventions to reduce imaging in children with mTBIs were eligible. DATA EXTRACTION Two independent reviewers screened studies, completed a quality assessment, and extracted data. The median of relative risks with interquartile range (IQR) are reported. A multivariable metaregression identified predictors of relative change in imaging. RESULTS Twenty-eight studies were included, and most (79%) used before-after designs. The Pediatric Emergency Care Applied Research Network (PECARN) rule was the most common intervention (71%); most studies (75%) used multifaceted interventions (median components: 3; IQR: 1.75 to 4). Before-after studies assessing multi-faceted PECARN interventions reported decreased computed tomography (CT) head imaging (relative risk = 0.73; IQR: 0.60 to 0.89). Higher baseline imagine (P < .001) and additional intervention components (P = .008) were associated with larger imaging decreases. LIMITATIONS The limitations of this study include the inconsistent reporting of important outcomes and that the results are based on non-randomized studies. CONCLUSIONS Implementing interventions in EDs with high baseline CT ordering using complex interventions was more likely to reduce head imaging in children with mTBIs. Including the PECARN decision rule in the intervention strategy decreased orders by a median of 27%. Further research could provide insight into which specific factors influence successful implementation and sustained effects.

中文翻译：

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减少轻度创伤性颅脑损伤儿童影像学检查的干预措施：系统评价。


背景 鼓励减少急诊科 （ED） 对轻度创伤性脑损伤 （mTBI） 儿童的不必要成像。目的 我们的目的是系统评价减少该人群影像学检查的干预措施的有效性。数据来源 检索了 8 个电子数据库和灰色文献。研究选择 评估 ED 干预以减少 mTBI 儿童影像学检查的比较研究符合条件。资料提取 两名独立评价员筛选研究，完成质量评估并提取资料。报告了四分位距 （IQR） 的相对风险中位数。多变量 meta 回归确定了成像相对变化的预测因子。结果 共纳入 28 项研究，大多数 （79%） 采用前后设计。儿科紧急护理应用研究网络 （PECARN） 规则是最常见的干预措施 （71%）;大多数研究 （75%） 使用了多方面的干预措施 （中位成分： 3;IQR：1.75 比 4）。评估多方面 PECARN 干预的前后研究报告称，计算机断层扫描 （CT） 头部成像减少（相对风险 = 0.73;IQR：0.60 至 0.89）。较高的基线想象 （P < .001） 和额外的干预成分 （P = .008） 与较大的影像学下降相关。局限性 本研究的局限性包括重要结局的报告不一致，以及结果基于非随机研究。结论 使用复杂干预措施对基线 CT 排序较高的 ED 实施干预更有可能减少 mTBI 患儿的头部成像。在干预策略中包括 PECARN 决策规则，订单数减少了 27% 的中位数。 进一步的研究可以深入了解哪些特定因素会影响成功实施和持续影响。