Minor head trauma doesn't warrant pediatric CT scan use

A new study has found that children who experience head trauma and only lose consciousness without suffering from any other symptoms don't need routine CT scans of the head.

In the study, published in the journal JAMA Pediatrics, researchers from UC Davis Health System and Boston Children's Hospital analyzed more than 40,000 children evaluated in hospital emergency settings. They found that children who lost consciousness after head trauma--but then were awake and alert in the emergency room, and had none of the other five factors deemed important under Pediatric Emergency Care Applied Research Network (PECARN) guidelines--had a low rate (0.5 percent) of clinically important brain injuries.

Furthermore, the researchers determined that the duration of loss of consciousness didn't significantly affect risk.

"Fear of missing a clinically significant head injury, and the wide availability of CT scanners, have been the main factors driving an increase in the use of CT imaging over the past two decades," co-author Nathan Kuppermann, a professor and chair of the UC Davis Department of Emergency Medicine, said in an announcement. "Our findings can help doctors confidently make a decision to forego CT testing when their patients are unlikely to benefit from it, enabling physicians to first observe their patients for a period of time before deciding on CT use."

Lead author Lois Lee, director of trauma research at Boston Children's Hospital, said that children with significant brain injuries rarely present to emergency departments with just lost of consciousness. For example, she said, they may show symptoms such as vomiting or demonstrate neurological problems.

"Being able to make treatment decisions backed by strong data helps doctors and parents feel better about deciding whether further testing is really needed," Lee said, adding that in cases in which parents are uneasy about their child's condition, they could keep the child under observation for several hours to see if any more symptoms develop before making a decision to have the child undergo a CT scan.

Kuppermann, in February 2013, helped to publish similar research in the Annals of Internal Medicine that identified several factors physicians should consider in helping to decide whether or not to perform CT scans on younger traumatic injury victims. That research focused on evaluating children who arrived at emergency departments in the PECARN after blunt trauma to their torsos, such as that caused by a fall or car or bicycle crash. 

"CT scans involve significant radiation risk, especially for children, who are more vulnerable than adults to radiation's effects," principal investigator and lead author James Holmes, a professor of emergency medicine at the University of California Davis School of Medicine, said. "We have now identified a population of pediatric patients that does not typically benefit from a CT scan, which is an important step in reducing radiation exposure."

To learn more:
- read the study in JAMA Pediatrics
- see the announcement from UC Davis Health System

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