New Guidelines on Need for CT Scans for Children with Head Trauma
Researchers from the University of California have published a new study validating prediction rules for identifying children at very low risk for clinically-important traumatic brain injuries for whom CT can routinely be obviated. The researchers, noting that CT imaging of head injured children has the risk of radiation-induced malignancy, aim to identify children at very low risk of clinically-important TBI for whom CT scans might be unnecessary. The research utilized patients under the age of 18 presenting with 24 hours of head trauma with Glasgow Coma Scale scores between 14-15 in 25 North American emergency departments.
The researchers analyzed over 42,000 children, obtaining CT scans on approximately 15,000 patients. Of those, clinically-important TBI occurred in about one percent (376) and of those, 60 underwent neurosurgery. The researchers concluded that for children younger than two years who had normal mental status, no scalp hematoma except frontal, no loss of consciousness or loss of consciousness for less than five seconds, non-severe injury mechanism, no palpable skull fracture and acting normally according to the parents, had a negative predictive value for clinically-important traumatic brain injury. For children aged two years and older, the prediction rule with normal mental status, no loss of consciousness, no vomiting, non-severe injury mechanism, no signs of basilar skull fracture and no severe headache had a negative predictive value of 99.95 percent and sensitivity of 96.8 percent. Neither rule missed neurosurgery in the validation populations.
The study was funded by the Emergency Medical Services for Children Programme of the Maternal and Child Health Bureau, and the Maternal and Child Health Bureau Research Programme, Health Resources and Services Administration, US Department of Health and Human Services. The study was published in the Lancet and can be found onilne here.