Interventions:
The interventions were described and appear to have been appropriate comparators.
Effectiveness/benefits:
The effectiveness data were from a retrospective before-and-after cohort study. The details of the cohort study were reported, including the inclusion criteria, patient sample, and follow-up period. The authors showed that the patients were comparable in their age, gender, and initial CT results, but it is possible that they differed in other characteristics. The reduced length of stay could have been due to changes in the general care and management of patients, rather than the guideline itself. The outcome measures were process related, rather than health or patient benefits, which reduces the generalisability of the benefit measure.
Costs:
The perspective was not stated, but seems to have been that of the health care provider (the hospital). The cost analysis was very simple; only the total hospital charges were analysed and the cost categories within this were not reported. This means it is not possible to determine if all the relevant costs were analysed. The price year was not reported, which will hamper any future inflationary exercises.
Analysis and results:
The statistical analyses used to test whether the differences between the two patient groups were significant were reported. The results were adequately presented. As the main limitation to their study, the authors reported that there was a lack of information on follow-up care. They stated that no child required hospital re-admission and there were no documented missed injuries, but they were unable to discover how many follow-up visits occurred, if there were any complications, and if there were any further scans at follow-up.
Concluding remarks:
There were a few limitations to the methods and some were not well reported. The analysis was based on a retrospective before-and-after cohort study and the outcome measures were process rather than health related, making it difficult to assess the cost-effectiveness of the guideline.