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

Felipe P Andrade,Roberto Montoro,Renan Oliveira,Gabriela Loures,Luana Flessak,Roberta Gross,Camille Donnabella,Andrea Puchnick,Lisa Suzuki,Rodrigo Regacini

doi:10.6061/clinics/2016(10)09

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.

Highlights

Head Trauma is responsible for more than 1.0 million emergency room (ER) visits, 95,000 hospitalizations, 7,000 deaths and 29,000 permanent disabilities, and in the United States (US) alone, costs surpass US $1.0 billion in hospital care annually [1,2,3]
This study aims to include the clinical variables that could affect decision-making about cranial computed tomography (CT) scans in pediatric minor head traumas and to address one of the most important issues that involves performing an imaging test: does the result change the therapeutic approach and justify the risks associated with exposure to ionizing radiation?
No type of injury described in the tables as other was significantly associated with abnormal imaging results

Summary

Introduction

Head Trauma is responsible for more than 1.0 million emergency room (ER) visits, 95,000 hospitalizations, 7,000 deaths and 29,000 permanent disabilities, and in the United States (US) alone, costs surpass US $1.0 billion in hospital care annually [1,2,3]. It is the leading trauma related morbidity/mortality in children worldwide and accounts for most indications of computed tomography (CT) scans in this group [4]. Clinical signs of intracranial brain injury (IBI) in children are less reliable, which increases the use of CT scans, which are a highly sensitive imaging tests that can detect early IBI or help to safely discharge patients with head traumas [1,2,3,4]

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Results

Conclusion