Neuroimaging for paediatric minor closed head injuries
1Division of Pediatric Emergency Medicine, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario.
Insights
Most pediatric minor head injuries do not require neuroimaging. This article discusses clinical decision rules and risk factors for computed tomography scans in children with head trauma.
Area of Science:
- Pediatric emergency medicine
- Radiology
- Clinical decision-making
Background:
- Paediatric minor head injuries are frequent.
- Neuroimaging is often unnecessary for these cases.
- Computed tomography (CT) scan use has increased.
Purpose of the Study:
- To discuss clinical decision rules for neuroimaging in paediatric minor head injuries.
- To review risk factors necessitating neuroimaging.
- To provide an update on recent evidence-based recommendations.
Main Methods:
- Review of clinical decision rules, including the Child and Adolescent Trial for Cardiovascular Health (CATCH) study.
- Identification of risk factors for neuroimaging.
- Synthesis of recent recommendations and evidence.
Main Results:
- Key risk factors include low Glasgow Coma Scale, suspected skull fractures, worsening headache, irritability, large scalp hematomas, and dangerous injury mechanisms.
- Guidelines aim to optimize CT scan utilization.
Conclusions:
- Evidence-based guidelines help identify paediatric patients with minor head injuries who require neuroimaging.
- Appropriate use of decision rules can prevent unnecessary CT scans.
Abstract:
It is clear that paediatric minor head injuries are common and that most cases may be observed without neuroimaging. However, with easier access to computed tomography scans, there has been an increase in its use. In the present article, clinical decision rules for neuroimaging of paediatric minor head injuries, such as the Child and Adolescent Trial for Cardiovascular Health (CATCH) study, will be discussed. Risk factors that should trigger concern are persistently low Glasgow coma scale, suspected open or basilar skull fracture, worsening headache, irritability, large and boggy scalp hematomas and dangerous mechanism of injury. An update on recent recommendations and evidence-based changes are provided.
