2013

INTRODUCTION: Head injury is a common presentation to the emergency department (ED). North American studies demonstrate increasing use of cranial computed tomography (CTB) to investigate head injury. No such data exists for Australian EDs. Aim: To describe CTB use and radiation dose in CTB over time in two Australian EDs.

METHODS: Retrospective medical record and radiology database audit by ICD 10 code for head injury in children < 16 years at a suburban general hospital (SG) and a tertiary referral children’s hospital (TR), in Melbourne, Victoria. Data were obtained from SG from 2008–2012, and TR from 2004–2012 including diagnosis, CTB use, CTB result and radiation dose in millisievert (mSv). Descriptive and comparative analysis of CTB rates and radiation dose delivered.

RESULTS: 8965 children with head injury were identified (7613 {85%} at TR and 1335 {15%} at SG). At TR and SG, 15.3% and 7.3% of children received a CTB, of which 2.9% and 1.4% had significant injury defined by PECARN criteria respectively. CTB use did not increase over time. Mean age of patients with CTB was 7.6 years. CTB was obtained more frequently in older children: 10 yo (19.1%). Mean radiation dose at TR decreased from 55.0 mSV to 25.0 mSV, and remained steady at SG at 13.3 mSv.

CONCLUSION: Compared with North America, CTB use in head injuries was less and did not increase during the study period. Radiation doses decreased over time.

BACKGROUND: There are no effective medications to improve the outcome of infants with bronchiolitis. Studies have shown the management of bronchiolitis to be varied even within the same region. Aim: To describe medication use at the seven study hospitals for a recent multi-centre randomised controlledtrial on hydration in bronchiolitis (Comparative Rehydration in Bronchiolitis (CRIB).

METHODS: A retrospective analysis of extant data of infants two months of age (corrected for prematurity) and 12 months of age admitted with bronchiolitis at seven hospitals in Australia and New Zealand identified through the CRIB trial. CRIB study records, pathology and radiology databases were used to collect data using a standardised form and entered on a database at a single site. Medications investigated included salbutamol, adrenaline, steroids, ipratropium bromide, normal saline and hypertonic saline, steroids and antibiotics.

RESULTS: There were 3456 patients admitted with bronchiolitis available for analysis, of which 42% received medication. Medication use in general varied by site between 27% and 48.7%. The most frequently used medications were salbutamol (25.5%). Medication use and salbutamol use increased by 8.2% and 9.3% respectively per month of age after four months. In patients admitted to ICU 81.6% received medication and 39.5% not admitted to ICU received medication.

Conclusion: Medication is being used frequently and variably in this region. Medication use and salbutamol use increased with age. Patients who were likely to be more unwell with bronchiolitis, that is those admitted to ICU or had investigations, also received medication and antibiotics more frequently

BACKGROUND: There are no effective medications to improve the outcome of infants with bronchiolitis. Studies have shown the management of bronchiolitis to be varied even within the same region. Aim: To describe medication use at the seven study hospitals for a recent multi-centre randomised controlledtrial on hydration in bronchiolitis (Comparative Rehydration in Bronchiolitis (CRIB).

METHODS: A retrospective analysis of extant data of infants two months of age (corrected for prematurity) and 12 months of age admitted with bronchiolitis at seven hospitals in Australia and New Zealand identified through the CRIB trial. CRIB study records, pathology and radiology databases were used to collect data using a standardised form and entered on a database at a single site. Medications investigated included salbutamol, adrenaline, steroids, ipratropium bromide, normal saline and hypertonic saline, steroids and antibiotics.

RESULTS: There were 3456 patients admitted with bronchiolitis available for analysis, of which 42% received medication. Medication use in general varied by site between 27% and 48.7%. The most frequently used medications were salbutamol (25.5%). Medication use and salbutamol use increased by 8.2% and 9.3% respectively per month of age after four months. In patients admitted to ICU 81.6% received medication and 39.5% not admitted to ICU received medication.

Conclusion: Medication is being used frequently and variably in this region. Medication use and salbutamol use increased with age. Patients who were likely to be more unwell with bronchiolitis, that is those admitted to ICU or had investigations, also received medication and antibiotics more frequently.