May 9, 2011

Doctors Suggest Waiting To Scan Kids For Brain Injury

According to a new study published in Pediatrics, observing kids after a head injury may help doctors determine if they need a head x-ray.

Researchers are still unsure whether too many of those x-rays, called computed topography, or CT scans, might trigger cancer later on in life.

Dr. Lise Nigrovic of Children's Hospital Boston, who worked on the study, said CT scans are a good strategy for kids who have some risk of a serious brain injury, but have not started showing symptoms. 

"CT isn't bad if you really need, but you don't want to use it in children who are at low risk for having a significant injury," Dr Nigrovic, who led the study, said in a statement.

"For parents, this means spending a couple of extra hours in the emergency department in exchange for not getting a CT. It's the children in the middle risk groups "“ those who don't appear totally normal, but whose injury isn't obviously severe "“ for whom observation can really help."

She told Reuters that if a kid shows up at the ER soon after a head injury, "you may just not have had enough time for symptoms to develop.  Or, a kid "may have some symptoms that make you a little concerned, but you just want some time" before making a decision about doing an x-ray.

"We all want to make sure that we use CT scanning in the cases where it's likely to be positive and that we save children from the radiation for those that we know are very unlikely to be positive," Dr. Martin Osmond, of the Children's Hospital of Eastern Ontario, told Reuters Health.

"This study adds important new information about who to observe" before making that decision, added Osmond, who has no ties to the new study.

The researchers reviewed data on over 40,000 kids with a head injury who were taken to one of 25 different emergency rooms.

The Pediatric Emergency Care Applied Research Network collected the original data.  Doctors treating the kids made a note in their records about whether each kid was kept in the hospital and observed by doctors and nurses before they decide whether or not to perform a CT scan.

The researchers studied about 5,400 kids.  About 31 percent of them had the head x-ray, versus 35 percent of kids when doctors made that decision right away.
Less than 1 of every hundred kids in both groups had a serious brain injury.

Twenty-six kids went home without a CT scan and came back later for an x-ray, while 1 of them ended up having a brain injury diagnosed by the x-ray.

Co-author Dr Nathan Kuppermann, chair of the Department of Emergency Medicine at UC Davis, told the Telegraph: "There is a clear need to develop appropriate and safe guidelines for decreasing the number of inappropriate head CT scans that we do on children."

"The results of this analysis demonstrate that a period of observation before deciding to use head CT scans on many injured children can spare children from inappropriate radiation when it is not called for, while not increasing the risk of missing important brain injuries."


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