APHIRST- Gap Australian Paediatric Head Injury Rules Study: Assessing the gap prior to implementation

This multicenter study has two primary aims; (1) we will assess Emergency Department-level variation in the use of CT scanning of the brain (CTB) in the diagnosis of children with mild head injury in tertiary, urban, and rural/regional hospitals in Australia and NZ, and identify potential hospital and/or patient level factors associated with CTB use; (2) we will identify and explore the clinician and organisational related factors influencing the use of CTB at participating Emergency Departments in children with head injuries and determine resource availability and need.

Each site will conduct a medical record audit to extract data relating to children who have presented with a head injury to the emergency department in 2016. Data will be extracted using a case report and entered into a web-based database.  Qualitative semistructured interviews will be conducted with invited doctors and nurses who treat children in the participating EDs, via telephone using a semi-structured interview proforma based on the Theoretical Domains Framework.

Study design

Retrospective observational study with Qualitative component.

Chief Investigator

Franz Babl

Time frame

2016 – 2018


National Health and Medical Research Council (ID 1058560)
Angior Family Foundation
Emergency Medicine Foundation
Royal Children’s Hospital Foundation

Site locations

  • Royal Children’s Hospital, Melbourne, Australia
  • Angliss Hospital, Upper Ferntree Gully,Victoria, Australia
  • Bendigo Hospital, Bendigo, Victoria, Australia
  • Box Hill Hospital, Box Hill, Victoria, Australia
  • Maroondah Hospital, Ringwood East, Victoria, Australia
  • Monash Children’s Hospital, Clayton, Victoria, Australia
  • Canberra Hospital, Canberra, ACT, Australia
  • Coffs Harbour Base Hospital, Coffs Harbour, NSW, Australia
  • Mt Druitt Hospital, Mt Druitt, NSW, Australia
  • Sutherland Hospital, Caringbah, NSW, Australia
  • Sydney Children’s Hospital, Randwick, NSW, Australia
  • Tamworth Hospital, Tamworth, NSW, Australia
  • Westmead Children’s Hospital, Westmead, NSW, Australia
  • Bundaberg Hospital, Bundaberg, QLD, Australia
  • Caloundra Hospital, Caloundra, QLD, Australia
  • Gold Coast University Hospital, Southport, QLD, Australia
  • Ipswich Hospital, Ipswich, QLD, Australia
  • Lady Cilento Children’s Hospital, Brisbane, QLD, Australia
  • Logan Hospital, Logan, QLD, Australia
  • Nambour Hospital, Nambour, QLD, Australia
  • Prince Charles Hospital, Chermside, QLD, Australia
  • Robina Hospital, Robina, QLD, Australia
  • Toowoomba Hospital, Toowoomba, QLD, Australia
  • Port Augusta Hospital, Port Augusta, SA, Australia
  • Women’s and Children’s Hospital, Adelaide, SA, Australia
  • Albany Regional Hospital, Albany, WA, Australia
  • Armadale Kelmscott, District Memorial Hospital, Mt Nasura, WA, Australia
  • Bunbury Regional Hospital, Bunbury, WA, Australia
  • Perth Children’s Hospital, Perth, WA, Australia
  • Starship Hospital, Auckland, New Zealand
  • Tauranga Hospital, Tauranga, New Zealand
  • Waikato Hospital, Waikato, New Zealand


3,200 records of children aged 0 – 16 years, diagnosed with head injury
40 semi-structured interviews with ED nursing and medical staff