CT scan in pediatric traumatic brain injury

As a general rule, in pediatric trauma patients with a Glasgow Coma Scale (GCS) less than 13, focal neurological deficits, and deteriorating consciousness should receive CT scan. However, for children with milder head injury, there is no clear consensus about requesting CT 7).

Most of the children with minor head trauma attend the emergency department nonsymptomatically or with minimal symptoms. Neurological examination is difficult in children, especially in newborns, infants (between one month and 12 months), and those under 3 years of age. Also, concern of the parents for their children and fear of malpractice litigation may force the physicians to request radiological imaging, especially the CT. The rate of requesting CT scans in children with minor head trauma (MHT) is between 5 and 50% 8).

There is a need for further prospective, multicentered studies with a large number of patients to make decision rules especially for children in this age group.

The fear of malpractice litigation should be reduced by various measures which will protect physicians such as robust departmental guidelines 9).

8) K. S. Quayle, D. M. Jaffe, N. Kuppermann et al., “Diagnostic testing for acute head injury in children: when are head computed tomography and skull radiographs indicated?” Pediatrics, vol. 99, no. 5, article e11, 1997.
7) B. Simon, P. Letourneau, E. Vitorino, and J. McCall, “Pediatric minor head trauma: indications for computed tomographic scanning revisited,” Journal of Trauma, vol. 51, no. 2, pp. 231–238, 2001.
9) Gülşen I, Ak H, Karadaş S, Demır I, Bulut MD, Yaycioğlu S. Indications of brain computed tomography scan in children younger than 3 years of age with minor head trauma. Emerg Med Int. 2014;2014:248967. doi: 10.1155/2014/248967. Epub 2014 Mar 2. PubMed PMID: 24724031.

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