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[Clinical observation: A safe alternative to radiology in infants with mild traumatic brain injury]
David Muñoz-Santanach1, Victoria Trenchs Sainz de la Maza1, Sara Maya Gallego1
1Servicio de Urgencias, Hospital Sant Joan de Déu Barcelona, Esplugues de Llobregat, Barcelona, España.
Insights
Clinical observation replaced X-rays for mild head injuries in infants, reducing imaging tests and hospital admissions without compromising traumatic brain injury (TBI) detection. This approach lowers radiation exposure and optimizes resource use.
Area of Science:
- Pediatric Emergency Medicine
- Neurotrauma Management
- Radiology and Imaging
Background:
- The management protocol for mild cranioencephalic trauma in pediatric emergency departments was updated in July 2013.
- The key change involved replacing routine cranial X-rays with clinical observation for infants.
Purpose of the Study:
- To assess if the protocol change reduced the detection rate of traumatic brain injury (TBI) in initial emergency visits.
- To evaluate the impact of the new protocol on imaging test requests and hospital admission rates for mild head injuries in children.
Main Methods:
- A retrospective, descriptive, observational study design was employed.
- Data were collected from two periods: Period 1 (pre-protocol change) and Period 2 (post-protocol change).
- Included were children aged 2 years or younger presenting with mild cranioencephalic trauma (Glasgow Scale modified for infants ≥14) of ≤24 hours onset.
Main Results:
- A total of 1,543 cases were analyzed (807 in Period 1, 736 in Period 2).
- While cranial fractures decreased significantly (4.3% vs 0.5%), TBI detection remained stable (0.4% vs 0.3%).
- Cranial X-ray and ultrasound use decreased dramatically, hospital admissions were reduced, and CT scan rates showed no significant change.
Conclusions:
- Clinical observation is a reliable alternative to cranial radiography for mild head injuries in infants, maintaining TBI detection accuracy.
- The protocol change successfully reduced imaging utilization and hospital admissions, leading to decreased radiation exposure and more efficient resource allocation.
Objective:
The protocol for the management of mild cranioencephalic trauma in the emergency department was changed in July 2013. The principal innovation was the replacement of systematic X-ray in infants with clinical observation. The aims of this study were to determine whether there was, 1) a reduction in the ability to detect traumatic brain injury (TBI) in the initial visit to Emergency, and 2) a change in the number of requests for imaging tests and hospital admissions.
Methodology:
This was a retrospective, descriptive, observational study. Two periods were established for the study: Period 1 (1/11/2011-30/10/2012), prior to the implementing of the new protocol, and Period 2 (1/11/2013-30/10/2014), following its implementation. The study included visits to the emergency department by children≤2 years old for mild cranioencephalic trauma (Glasgow Scale modified for infants≥14) of ≤24hours onset.
Results:
A total of 1,543 cases were included, of which 807 were from Period 1 and 736 from Period 2. No significant differences were observed as regards sex, age, mechanism, or risk of TBI. More cranial fractures were detected in Period 1 than in Period 2 (4.3% vs 0.5%; P<.001), without significant changes in the detection of TBI (0.4% vs 0.3%; P=1). However, there were more cranial X-rays (49.7% vs 2.7%; P<.001) and more ultrasounds (2.1% vs 0.4%; P<.001) carried out, and also fewer hospital admissions (8.3% vs 3.1%; P<.001). There were no significant differences in the number of computerised tomography scans carried out (2% vs 3%; P=.203).
Conclusions:
The use of clinical observation as an alternative to cranial radiography leads to a reduction in the number of imaging tests and hospital admissions of infants with mild cranioencephalic trauma, without any reduction in the reliability of detecting TBI. This option helps to lower the exposure radiation by the patient, and is also a more rational use of hospital resources.
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