A considerable number of CT scans performed on children with head injuries are unnecessary, researchers from Boston Children’s Hospital Boston and UC Davis reported in the journal Pediatrics. If more children were placed under observation, the need for CT (Computed Tomography) scans would be significantly less, they added.
Approximately half of all American children who arrive at hospital emergency department with a head injury undergo a CT scan. In many cases, staff say parental concern and pressure may influence diagnostic decisions.
In a head CT scan, several X-rays are directed simultaneously from various angles so that a picture of the inside of the brain can be created. CT scans help detect brain tumors, they make it easier for health care professionals to determine whether there is any bleeding and how bad it is.
However, X-ray exposure slightly raises the patient’s lifetime risk of developing cancer. As children are at the beginning of their lives, their risk is greater.
Doctors tend to underestimate CT scan radiation risk, a 2007 NEJM (New England Journal of Medicine) study revealed. The authors believe there may be over 1 million unnecessary CT scans performed on American children annually.
If a child with a head injury were kept under observation for a little longer, perhaps a few hours when they enter an emergency department, a significant number of them would end up not needing a CT scan, and would not be exposed to X-rays, the authors of the Pediatrics article wrote.
Co-lead author Dr Lise Nigrovic, said:
“Only a small percentage of children with blunt head trauma really have something serious going on.”
Not only would fewer CT scans be better for children’s long-term health, it would also reduce costs. CT scans are extremely useful if the patient really needs it, Nigrovic said, but children who are at low risk of serious injury do not often need it.
As far as parents are concerned, it would mean waiting in the hospital a few hours longer while the child is under observation.
“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.”
Nigrovic and team gathered data from PECARN (the Pediatric Emergency Care Applied Research Network), a subset of data from a larger study.
They examined the outcomes of over 40,000 child patients with head injuries in 25 emergency departments. 14% were kept under observation before deciding whether to order a CT scan. 31% of those kept under observation subsequently underwent a CT scan, compared to 35% who were not observed.
As the head injuries became more severe, the difference between those placed under observation and those not widened – children placed under observation had half the likelihood of having to undergo a CT scan. In many cases, while being observed, the children’s symptoms improved.
A further study is required which would look at how long children were under observation – this was not done in this study, the authors added. Children should be kept under observation after a head injury for between 4 and 6 hours, according to the American Academy of Pediatrics.
The following steps should be taken if your child has a head injury, says Nigrovic:
- Before taking your child to the emergency department, consult with your GP (general practitioner, primary care physician, family doctor)
- If the child seems confused, vomits or has a headache take him/her straight to the emergency department.
- If the child’s symptoms appear to be getting worse, take him/her straight to the emergency department
- At the hospital, accept that the medical staff may recommend placing the child under observation for a few hours before deciding on whether to order a CT scan. It gives the doctors time to see whether symptoms are changing, which helps them make that decision.
“The Effect of Observation on Cranial Computed Tomography Utilization for Children After Blunt Head Trauma”
Lise E. Nigrovic, MD, MPH, Jeff E. Schunk, MD, Adele Foerster, MSN, Arthur Cooper, MD, Michelle Miskin, MS, Shireen M. Atabaki, MD, MPH, John Hoyle, MD, Peter S. Dayan, MD, MS, James F. Holmes, MD, MPH, Nathan Kuppermann, MD, MPH
Pediatrics Doi: 10.1542/peds.2010-3373
Written by Christian Nordqvist