Pediatric minor head trauma: do cranial CT scans change the therapeutic approach?

Abstract

OBJECTIVES:1) To verify clinical signs correlated with appropriate cranial computed tomography scan indications and changes in the therapeutic approach in pediatric minor head trauma scenarios. 2) To estimate the radiation exposure of computed tomography scans with low dose protocols in the context of trauma and the additional associated risk.METHODS:Investigators reviewed the medical records of all children with minor head trauma, which was defined as a Glasgow coma scale ≥13 at the time of admission to the emergency room, who underwent computed tomography scans during the years of 2013 and 2014. A change in the therapeutic approach was defined as a neurosurgical intervention performed within 30 days, hospitalization, >12 hours of observation, or neuro-specialist evaluation.RESULTS:Of the 1006 children evaluated, 101 showed some abnormality on head computed tomography scans, including 49 who were hospitalized, 16 who remained under observation and 36 who were dismissed. No patient underwent neurosurgery. No statistically significant relationship was observed between patient age, time between trauma and admission, or signs/symptoms related to trauma and abnormal imaging results. A statistically significant relationship between abnormal image results and a fall higher than 1.0 meter was observed (p=0.044). The mean effective dose was 2.0 mSv (0.1 to 6.8 mSv), corresponding to an estimated additional cancer risk of 0.05%.CONCLUSION:A computed tomography scan after minor head injury in pediatric patients did not show clinically relevant abnormalities that could lead to neurosurgical indications. Patients who fell more than 1.0 m were more likely to have changes in imaging tests, although these changes did not require neurosurgical intervention; therefore, the use of computed tomography scans may be questioned in this group. The results support the trend of more careful indications for cranial computed tomography scans for children with minor head trauma.

Effect of parental pressure on emergency physicians for computerized tomography imaging request in children with head trauma

“…Although self-level falling is not considered a serious trauma mechanism, in the study by Andrade et al, 30% of the patients who had undergone CCT scans comprised patients falling at their own level, and 7.9% of them had abnormal imaging findings [8]. In the study of Klassen et al, only 5 (1.7%) of 296 patients admitted due to falling from a height of b90 cm (including those falling from their own level).…”

“…One of the primary questions asked in the anamnesis of a trauma patient admitted to the emergency department is the mechanism of trauma. The mechanism of trauma may sometimes be an indication for imaging alone [6,8]. Many studies have reported that the most common mechanism of trauma in children is falling (70% in Powel et al, 81% in Andrade et al, 47% in Klassen et al, and 52.6% in Alharthy et al) [7][8][9][10].…”

“…The mechanism of trauma may sometimes be an indication for imaging alone [6,8]. Many studies have reported that the most common mechanism of trauma in children is falling (70% in Powel et al, 81% in Andrade et al, 47% in Klassen et al, and 52.6% in Alharthy et al) [7][8][9][10]. The height of falls is considered as an important indicator of the severity of trauma and is a parameter that affects the tendency of performing CCT scans.…”

Timing of presentation and correlation with computed tomography in pediatric patients with minor head trauma

“…When such patients are subjected to repeated CT examination, there is an iatrogenic risk of inducing repeated low dose radiation, which may result in cancers in adult life. 15…”

Kryteria kliniczne kwalifikacji dziecka z lekkim urazem głowy do badania tomografii komputerowej ocenione w materiale własnym

“…[17], natomiast ma potwierdzenie w danych przedstawionych przez Andrade i wsp. [22]. Wymioty po lekkim urazie głowy notowano u 35% dzieci.…”