Is repeat head computed tomography necessary in children admitted with mild head injury and normal neurological exam?
Emily C Dawson1, Christopher P Montgomery, David Frim
1Department of Pediatrics, University of Chicago, Chicago, IL 60637, USA. edawson@uchicago.edu
Insights
Repeat head CTs for children with mild head injury (MHI) and normal exams may be unnecessary. This study found no management changes despite repeat imaging, suggesting it could be avoided in this patient group.
Area of Science:
- Pediatric Emergency Medicine
- Radiology
- Trauma Surgery
Background:
- Children with mild head injury (MHI) frequently receive repeat head computed tomography (HCT) to monitor for injury progression.
- Evidence supporting the routine use of repeat HCT in MHI cases is limited.
Purpose of the Study:
- To evaluate the necessity of repeat head CT scans in pediatric patients diagnosed with mild head injury.
- To analyze the impact of initial HCT results on length of stay and subsequent imaging in MHI patients.
Main Methods:
- Retrospective review of medical records for 507 pediatric patients (2 months to 18 years) admitted with MHI.
- Analysis of data including Glasgow Coma Scale, loss of consciousness, length of stay, and number/results of HCTs.
- Comparison between patients with normal and abnormal initial HCT findings.
Main Results:
- Of 507 patients, 389 had normal initial HCT and 118 had abnormal initial HCT.
- Patients with abnormal initial HCT had a longer median length of stay (36.63 h vs. 17.68 h) and more HCTs (median 2 vs. 1).
- No patient management was altered based on repeat HCT findings in either group.
Conclusions:
- Children with MHI, normal neurological exams, and abnormal initial HCTs experienced longer hospital stays and required more HCTs.
- Repeat HCT did not lead to changes in clinical management for any patient.
- Routine repeat HCT may be unnecessary for pediatric patients with MHI and a normal neurological examination.
Background:
Children admitted following mild head injury (MHI) often undergo repeat head computed tomography (HCT) to identify progression of injury, although there is little evidence to support this practice.
Methods:
From January 2007 to December 2009, we retrospectively reviewed the medical records of patients aged 2 months to 18 years admitted with a diagnosis of MHI to a Level I Pediatric Trauma Center. Data including Glasgow Coma Scale, loss of consciousness, length of stay (LOS), and number and results of HCTs were analyzed.
Results:
A total of 507 patients were admitted with MHI and normal neurological exam; 389 had a normal and 118 had an abnormal initial HCT. The median LOS in the normal HCT group was 17.68 h (5.47-109.68) and in the abnormal HCT group 36.63 h (10.15-192.40). The median number of HCTs in the normal HCT group was 1 (1-2) and in the abnormal HCT group 2 (1-5).
Conclusions:
Children admitted with MHI, abnormal initial HCT and normal neurological exam had longer LOS and more HCTs compared with children with normal initial HCTs. No patient in either group had any change in their management based on HCT. Therefore, repeat HCT may be unnecessary for patients with MHI and normal neurological exam.
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