CT scan for kids with minor head injury risky, often unnecessary

Kathleen Blanchard's picture
CT scan in chldren with head injury not always necessary
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A large study shows CT scans of the head expose kids to radiation, but few are even necessary.

Findings from the analysis shows most CT scans of the head are often ordered just to ease parental concerns about brain injury.

In the investigation of more than 40,000 children with minor head trauma, researchers at Children's Hospital Boston and UC Davis found over half of kids taken to emergency departments for minor head injury receive a scan, but few were at risk for brain injury.

Most head injuries in kids not serious

Study co-leader Nathan Kuppermann, MD, MPH, chair of the Department of Emergency Medicine at UC Davis explains, "If you can be watched in the ED for a few hours, you may not need a CT." Kuppermann says few head injuries are serious and observing most children would not only cut costs, but is just better medicine.

The analysis for the study included 40,113 children who were part of the Pediatric Emergency Care Applied Research Network (PECARN) from 25 different emergency rooms.

Children who were watched in the emergency room were half as likely to get a CT scan. When the researchers looked at the number of serious head injuries that lead to hospitalization, death or surgery, the rate was 0.75 vs.0.87 percent in the observed and non-observed group respectively.

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"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," says Lise Nigrovic, MD, MPH, of Children's Hospital Boston. "

For parents, this means spending a couple of extra hours in the ED 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."

Kupperman says there’s a need to establish guidelines to keep kids safe from unnecessary CT scans that could later lead to malignancy, but still provide needed care for those who might have brain injury.

Nigrovic explains parents who take their kids to the emergency department could reasonably be asked to stay for a few hours to see if a CT scan is needed. For kids with vomiting, headache and confusion, a visit to the hospital is appropriate – for others, Nigrovic suggests parents check with the child’s physician to see if a trip to the ED is even necessary.

The study, published in the journal Pediatrics, highlights the overuse of CT scans in kids that weren’t needed in half the cases analyzed that put children at risk, increasing the chances of malignancy later in life. CT scans are most appropriate in children whose symptoms change over time.

Pediatrics 2011; 127: 1067-1073
"The effect of observation on cranial computed tomography utilization for children after blunt head trauma"
Nigrovic L, et al

Image credit: Morguefile.com

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