Longer ER observation leads to fewer pediatric CT scans

The longer a child with minor blunt head trauma is observed in an emergency room, the less likely he or she will need to undergo a CT scan, according to a study published online in the Annals of Emergency Medicine.

"Every hour of observation time in the emergency department was associated with a decrease in CT rates for children whether at low, intermediate or high risk of traumatic brain injury," lead study author Lise Nigrovic, M.D., of Boston Children's Hospital said in an announcement. "Furthermore, observation prior to CT decision-making for children with minor blunt head trauma was associated with reduced CT use without an observed delay in the diagnosis of significant traumatic brain injury."

The researchers examined the cases of 1,381 children, 676 (49 percent) of whom were observed in the emergency department prior to a decision on whether or not to perform a CT scan was made. They found that most children's symptoms improved during the course of observation, and that every hour of observation reduced the necessity for a CT scan by 70 percent, on average.

Considering that more than 500,000 children annually go to emergency departments to be evaluated for blunt head trauma, the results of the study could help physicians avoid giving children needless CT scans that will expose them to ionizing radiation.

"As emergency physicians, we must balance the possibility of missing a clinically significant traumatic brain injury with the future risk of malignancy associated with ionizing radiation exposure," Nigrovic said. "Observation prior to CT decision-making has the potential to further reduce CT rates without missing children with significant injuries, further improving the emergency care of children with minor blunt head injury."

To learn more:
- see the study published online in the Annals of Emergency Medicine
- read the announcement