More than 450,000 children with blunt head trauma are seen in emergency departments (EDs) each year in the U.S. A CT scan is the quickest way to identify a traumatic brain injury (TBI) in these children, but the scans are also associated with a small increased risk of a cancer later in life.

A recent study published in Archives of Pediatric and Adolescent Medicine, suggests that many of these children probably don’t need a CT scan. The investigators found that children who have severe mechanisms of injury but no worrisome symptoms or physical signs are at low risk of clinically important TBIs.

“This study shows that many of the children with minor head trauma who have a more severe injury mechanism are at low risk of important traumatic brain injuries and just need careful evaluation and observation by an ED provider,” says Peter Dayan, MD, MSc, associate professor of clinical pediatrics at Columbia and a co-author of the study.

The study used data from a multi-center investigation of 44,000 children led by Dr. Nathan Kuppermann at University of California, Davis, and conducted in the Pediatric Emergency Care Applied Research Network (PECARN). The majority of these 44,000 children needed evaluation from a physician, but not necessarily a CT scan. Such children don’t have clear signs of TBI (such as being unconsciousness) but they have some risk factors associated with TBI.

In the publication in the Archives, the authors analyzed a group of children with one risk factor: a severe mechanism of injury. Severe mechanisms include being in a car crash with a passenger death, being hit by a motor vehicle, or falling from an elevated height.

Despite sustaining a blunt head injury via a severe mechanism, the risk of TBI in this group was very low. Only 16 patients among the approximately 3300 who fell into the severe mechanism category had clinically important TBIs if they had no important signs or symptoms associated with TBI.

The study investigators are now analyzing the data to see if children with other single risk factors, like vomiting, also have a low risk of TBI.

“Children with minor head injuries are a puzzle, and we hope that these analyses will result in better guidelines for physicians trying to balance the risk of the CT scan with the risk of missing clinically important brain injuries,” Dayan adds.

--Susan Conova

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