When is it safe to forego a CT in kids with head trauma?

When is it safe to forego a CT in kids with head trauma? New clinical prediction rules make it easier to identify children at low risk of serious brain injury—and reduce the reliance on CT scanning. Use these newly derived and validated clinical prediction rules to decide which kids need a CT scan after head injury. A: Based on consistent, good-quality patient-oriented evidence. Kuppermann N, Holmes JF, Dayan PS, et al. Identifi cation of children at very low risk of clinically-important brain injuries after head trauma: a prospective cohort study. An anxious mother rushes into your offi ce carrying her 22-month-old son, who fell and hit his head an hour ago. The child has an egg-sized lump on his forehead. Upon questioning his mom about the incident, you learn that the boy fell from a seated position on a chair, which was about 2 feet off the ground. He did not lose consciousness and has no palpable skull fracture—and has been behaving normally ever since. Nonetheless, his mother wants to know if she should take the boy to the emergency department (ED) for a computed tomography (CT) head scan, " just to be safe. " What should you tell her? T raumatic brain injury (TBI) is a leading cause of childhood morbidity and mortality. In the United States, pediatric head trauma is responsible for 7200 deaths, 60,000 hospitalizations, and more than 600,000 ED visits annually. 2 CT is the diagnostic standard when significant injury from head trauma is suspected, and more than half of all children brought to EDs as a result of head trauma undergo CT scanning. 3 CT is not risk free CT scans are not benign, however. In addition to the risks associated with sedation, diagnostic radiation is a carcinogen. It is estimated that between 1 in 1000 and 1 in 5000 head CT scans results in a lethal malignancy, and the younger the child, the greater the risk. 4 Th us, when a child incurs a head injury, it is vital to weigh the potential benefi t of imaging (discovering a serious, but treatable, injury) and the risk (CT-induced cancer). Clinical prediction rules for head imaging in children have traditionally been less reliable than those for adults, especially for preverbal children. Guidelines agree that for children with moderate or severe head injury or with a Glasgow Coma Scale (GCS) score ≤13, CT is defi nitely recommended. …