Computed Tomography in Pediatric Traumatic Brain Injury: Who Needs It and How Is It Scored?

Abstract

Head trauma is one of the most common reasons for children to visit the emergency room in the United States. Computed tomography (CT) utilization for pediatric head trauma continues to increase despite public concern regarding ionizing radiation exposure. More than 90% of the imaging studies in children with minor head trauma are negative for traumatic brain injuries (TBIs). Judicious use of head CT is important to reduce unnecessary ionizing radiation in the vulnerable pediatric population. With the goal of reducing unnecessary CT for pediatric TBI patients, an important question is not “who needs head CT” but “who can safety avoid head CT.” When abnormal CT findings are present for moderate or severe TBI patients, accurate and reproducible scoring systems are also necessary to make CT reports actionable and meaningful for physicians in the trauma team. This article outlines the current evidence-based practices for pediatric head CT use, highlighting relevant clinical decision-making tools, as well as reviews the current CT-based trauma scoring systems.