May 10, 2011
CT Scans Unnecessary in Children with Head Trauma
(Ivanhoe Newswire) -- Overall, roughly half of U.S. children taken to hospital emergency departments (EDs) for a head injury receive a head CT scan, often to ease worried parents' concerns. Yet true traumatic brain injury is uncommon. A multi-center study of more than 40,000 children with minor blunt head trauma, led by Children's Hospital Boston and UC Davis, shows that allowing a period of observation can reduce the use of head CT by as much as half without compromising care "“ and without exposing children to ionizing radiation.
"Only a small percentage of children with blunt head trauma really have something serious going on," Lise Nigrovic, M.D., MPH, of Children's Hospital Boston, who co-led the study with Nathan Kuppermann, M.D., MPH, chair of the Department of Emergency Medicine at UC Davis, was quoted as saying. "If you can be watched in the ED for a few hours, you may not need a CT."This change in practice would not only be cost-saving, but is better medicine, the researchers say. Nigrovic, Kuppermann and colleagues analyzed the outcomes of children presenting at 25 different emergency departments, as part of a large prospective study conducted by the Pediatric Emergency Care Applied Research Network (PECARN). Of 40,113 children whose records could be analyzed, 5,433 (14 percent) were observed before making a decision about CT use.
Overall, the children who were observed had a lower rate of CT than those not observed (31 vs. 35 percent). When the researchers matched the observed and non-observed groups for severity of head injury and the practice style of different hospitals, this difference was more pronounced: The likelihood of a CT scan in the observed group was about half that of similar non-observed patients (odds ratio, 0.53). In particular, children whose symptoms improved during observation were less likely to eventually have CT.
Allowing for an observation period did not compromise safety, the study found: Clinically important traumatic brain injury -- resulting in death, neurosurgical intervention, intubation for more than 24 hours or hospital admission for two nights or more -- was equally uncommon in the observed and non-observed groups (0.75 vs. 0.87 percent).
Nigrovic and Kuppermann note that cranial CT itself presents additional risks for children. Children's growing brain tissue is more sensitive to ionizing radiation than adults', and because of their longer life expectancy, their lifetime risk of developing a radiation-induced malignancy is greater.
Nigrovic offers the following general guidelines for parents whose child has a head injury: Check with your primary care clinician before taking the child to the ED; if your child has headache, vomiting and/or confusion, or symptoms that worsen over time, an ED visit is appropriate; the ED clinician may reasonably choose to observe your child for several hours once you arrive before deciding about a head CT; the change of symptoms over time is an important factor in deciding whether to obtain a cranial CT.
SOURCE: Pediatrics, May 9, 2011