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CT scans not always necessary in kids' head trauma
May 9th, 2011
12:01 AM ET

CT scans not always necessary in kids' head trauma

When children are taken to the hospital with bumps to the head, many receive brain CT scans to determine the damage. Yet, according to statistics, in most cases, traumatic brain injury does not occur and the child is fine. Now new research finds that observing a child with head injuries for a certain period of time can help physicians determine whether the child has a serious problem without using CT scans. This not only cuts down on the cost of the visit, but also eliminates unnecessary exposure to unwanted radiation.

The study, led by Children's Hospital Boston and the University of California-Davis, and released, by the Pediatric Emergency Care Applied Research Network, looked at more than 40,000 children with minor blunt head trauma. Combining the data from 25 different emergency departments, researchers found more than 5,400 pediatric patients or about 14%t of those studied, were observed before making a decision about CT use. Observation times varied, as did the severity of head trauma.

Overall, the children who were observed had a lower rate of having CT scans than those not observed, (About 31% vs. 35%). And the likelihood of a child receiving a CT scan in the observed group was about half that of non-observed patients. In particular, children whose symptoms improved during observation were less likely to eventually have CT scans. The question is, how do doctors know who's at risk for further injury if  a CT scan is not administered?

"There are actually three groups of patients that come into an emergency room with pediatric head trauma," says Dr. Lise Nigrovic of Children's Hospital Boston who co-led the study. "The first is the child that really has no symptoms and it's obvious to the doctors that the child is fine. The second is the child that has all the major symptoms, vomiting, headaches, unconsciousness, perhaps bleeding. That child is obviously a candidate for a CT scan. 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."

So why not just perform a CT scan on an injured child just for safe measure? Researchers note that CT scans to the head can add additional risks for children. That's because a little one’s growing brain tissue is more sensitive to ionizing radiation than an adult's, and because of their longer life expectancy, their lifetime risk of developing a radiation-induced tumors is greater.

"CT isn't bad if you really need it, but you don't want to use it in children who are at low risk for having a significant injury," says Nigrovic. "For parents, this means spending a couple of extra hours in the emergency department in exchange for not getting a CT. And most parents are on board with that idea."

When it comes to "how long" a child should be observed in the emergency room after head trauma, that remains undetermined. Although guidelines from the American Academy of Pediatrics recommend a child be carefully observed for four to six hours after injury, researchers in this study believe the length of observation times should be studied further.

The study results appear in the June 2011 issue of Pediatrics.


soundoff (14 Responses)
  1. James Katt

    Sure. It would be "statistically unnecessary" to get a CT.

    If it was your child, would you want a CT of not?????

    If it was the doctor's child, would he or she want a CT or not????

    I think the answer would be YES.

    May 9, 2011 at 09:30 | Report abuse | Reply
    • DT

      I AM a pediatrician, and my kids HAVE had mild head injury in the past, and with only mild symptoms I would definitely NOT want them to have a CT scan, which exposes their young brain to a fair amount of radiation.

      May 10, 2011 at 12:40 | Report abuse |
    • ap,

      i am a physician, and i do NOT want my child to be scanned every time he hits his head. at current utilization rates, in about 20 years, 2% of ALL cancers will be attributable to excess CT radiation (NEJM). that is NOT insignificant.

      May 10, 2011 at 16:03 | Report abuse |
    • dgatwood

      Is there a reason that an MRI could not be used to show the same thing? It's a heck of a lot safer than a CT scan. I mean, assuming the person isn't screwed up enough that he/she is on an IV drip, that is.... I know if it were my kid, I'd insist on an MRI (preferably with no contrast, since gadolinium isn't the nicest thing to have floating around your body), and I'd flat out refuse a CT.

      June 6, 2011 at 22:55 | Report abuse |
  2. Sarah James

    This is a lie. you always get a ct scan to ensure there is no internal bleeding, trauma not seen by the naked eye. Who did this study? They must not have a medical license are just saying that because most times the child is okay, you shouldn't do it. That conclusion will kill many more people.

    May 9, 2011 at 12:21 | Report abuse | Reply
    • docajl

      Sarah, you may be taking your child to a non-pediatric hospital to have him evaluated. As a board-certified pediatrician, I have worked in hospitals where that was the case and, except for my intervention, many children would have unnecessarily received 200 times the ionizing radiation of a chest x-ray. If it were my child with a normal exam, I certainly would not opt for a CT scan.

      May 9, 2011 at 19:48 | Report abuse |
    • DT

      Sarah,
      You absolutely do NOT need to get a CT scan with mild symptoms, as even if there IS a small bleed, intervention (ie, surgical) will usually not be done. Now, if the bleed continues and the kid's mental status or vomiting becomes worse, then you may need to intervene, so a CT scan is of course justified. But for mild symptoms that are not progressive, observation is the way to go.
      As always, it's a risk/benefit calculation. There is a risk from CT scans, and one that should not be taken lightly. I say this as a pediatrician going into radiology.

      May 10, 2011 at 12:43 | Report abuse |
    • jon

      sarah, what is your medical background? this board seems to have alot of physicians who disagree with you

      May 10, 2011 at 16:16 | Report abuse |
  3. Ann

    Every procedure/medication/imaging technique has risks, and pediatricians must weigh those risks vs. the benefits when they make decisions. A CT scan, which is a great study when needed, carries with it a risk of radiation exposure. If this was my child, and she/he had a low risk of having an injury that would require intervention, I would absolutely not want them to have a CT scan.

    May 9, 2011 at 13:10 | Report abuse | Reply
  4. Clint

    I am also a physician and agree that CT is EXTREMELY over utilized in the emergency department. This overutilization occurs for both children and adults. It my hope that through more patient and physician education this will begin to change and irrational reactions like Sarah's will be the exception and not the rule. BTW, it is comical that the report is about CT utilization and all the images shown are MRIs.

    May 10, 2011 at 12:55 | Report abuse | Reply
  5. Kathy

    I am the parent of a children with blood clotting issues. My oldest died of a brain bleed at the age of 8. She had a sagital sinus venous thrombosis. We have a genetic issue. My son who is 9, gets a CT ONLY if he sustains an injury that requires a quick check. Otherwise he gets brain MRI's if we have time to do them.

    May 10, 2011 at 15:21 | Report abuse | Reply
  6. Brad

    I agree with Sarah. If my child had a head injury as a parent I want a ct scan done. If it was your child regardless of symptoms you would want a ct scan. I do not care if you have a md behind your name .

    May 12, 2011 at 15:54 | Report abuse | Reply
    • Clint

      Brad,

      Not true, I have a 4 year old daughter that fell and had a big knot and hematoma on her forehead. We observed her at home and she did not develop any worrisome or progressive neurologic symptoms. She did not get a CT scan, or even go to the ED for that matter.

      May 13, 2011 at 14:47 | Report abuse |
  7. Cynical about not taking 4 year old to ER

    I find it hard to believe that physicians are responding who have not been paid by the insurance company. Scans are expensive to your insurance company. It benefits them if you do not get the scan or as CLINT says not even take your injured 4 year old in to the ER. What you are waiting for is if your child dies or not. If they die, you needed the scan, if they don't they didn't need it. If there is a chance the scan will help according to a doctor (independent of insurance or drug company payments) shouldn't you get it? This is draconian and clearly smells of economics. Follow the money. With all the drug company news that they make up studies and mislead doctors we need to be vigilant to protect our children and our right to have tests we determine (with our doctor's advice) our children need.

    June 6, 2011 at 18:52 | Report abuse | Reply

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