Not All Kids With Head Injuries Need Brain Scans

MONDAY Sept. 14, 2009 -- Guidelines to identify children with a very low risk of serious brain injury after they've suffered a head injury are highly effective and can reduce the use of scans that expose children to radiation, a new study has found.

U.S. researchers analyzed data on more than 42,000 children who experienced a head injury, including computed tomography (CT) scan results on 35 percent of the children. Clinically important traumatic brain injuries occurred in 376 (1 percent) of the children and, of those, 60 underwent neurosurgery.

Characteristics used to predict which children younger than age 2 didn't have a clinically important traumatic brain injury were: normal mental status, no scalp swelling except frontal, no loss of consciousness or unconscious for under five seconds, non-severe injury mechanism, no noticeable skull fracture, and parents reporting normal behavior in the child.

Using these guidelines, the researchers accurately predicted 100 percent of 1,176 patients who didn't have clinically important traumatic brain injury. Among children under age 2 in this low-risk group, 24 percent received a CT scan, the researchers noted.

In children aged 2 to 18 years, clinical characteristics used for screening included: normal mental status, no loss of consciousness, no vomiting, non-severe injury mechanism, no signs of basilar skull fracture, and no severe headache. These guidelines correctly predicted all but two of 3,800 patients (99.95 percent) who didn't have clinically important traumatic brain injury. Twenty percent of patients in this low-risk group received a CT scan, the study authors added.

The study appears online Sept. 14 and in an upcoming print issue of The Lancet.

Using these clinically important traumatic brain injury prediction rules could have avoided the use of CT scans and resulting radiation exposure in 25 percent of children younger than 2 years old and in 20 percent of children older than 2 years, study author Dr. Nathan Kuppermann, of the University of California, Davis Medical Center in Sacramento, and colleagues, said in a news release.

More information

The Nemours Foundation has more about children and head injuries.

Posted: September 2009


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