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Pediatric minor head injury imaging practices: results from an ESPR survey
Maria I Argyropoulou1, George A Alexiou2, Vassileios G Xydis1
1Department of Radiology, Medical School, University of Ioannina, Ioannina, Greece.
Insights
Computed tomography (CT) for pediatric minor head injury involves radiation risks. Improving adherence to decision rules and optimizing CT protocols can reduce unnecessary scans in children with minor traumatic brain injury (TBI).
Area of Science:
- Pediatric Radiology
- Medical Imaging
- Radiation Safety
Background:
- Computed tomography (CT) for minor head injury in children exposes them to ionizing radiation, increasing lifetime cancer risk.
- Current imaging practices for pediatric minor head injury and radiologist awareness of clinical decision rules for traumatic brain injury (TBI) require investigation.
Purpose of the Study:
- To assess current CT imaging practices for children with minor head injury.
- To evaluate radiologists' awareness and application of clinical decision rules for pediatric TBI.
Main Methods:
- An electronic questionnaire was sent to 472 European Society of Pediatric Radiology (ESPR) members.
- Questions covered demographics, practice setting, CT use for pediatric head trauma, decision rule awareness, shielding, pediatric CT protocols, and MRI use.
Main Results:
- A low response rate (18.4%) was observed. Most respondents were over 50 years old and full-time consultants.
- 73.8% cited NICE guidelines; 79% reported shared decision-making for CT. Shielding was used by 58.3%, and 67.4% used pediatric protocols.
- MRI was underutilized (70.6% not using it) due to machine availability, long scan times, and patient intolerance.
Conclusions:
- There is potential to reduce CT utilization for pediatric minor TBI.
- Improvements in shielding practices and adherence to pediatric CT protocols are recommended.
Purpose:
Computed tomography (CT) for minor head injury exposes a large number of children to ionizing radiation, with an associated increased lifetime risk of malignancy. To study imaging practices for children with minor head injury and the level of awareness of radiologists of the current clinical decision rules for minor traumatic brain injury (TBI).
Methods:
A questionnaire consisting of 17 questions was distributed electronically to 472 ESPR members. The questionnaire covered demographic information, employment status, years of experience and the current practice setting of the participants, the number of CTs performed for pediatric head trauma, awareness of clinical decision rules and use of shielding, pediatric CT protocol and MRI.
Results:
The response rate was 18.4%. The majority of participants was aged over 50 years and was full-time consultants. Regarding decision rules, 73.8% of respondents cited the NICE head injury guidelines, and 79% reported that the decision to perform CT was agreed between specialists. Shielding was used by 58.3% and 67.4% applied a specific pediatric protocol. MRI was not used for pediatric head trauma by 70.6% of respondents, although always available in 68.6% of cases. The reported obstacles to MRI use were machine availability (42.7%), the long acquisition time (39%) and patients' intolerance (18.3%), and less frequently the cost and the need for sedation.
Conclusion:
There is room for decreasing the use of CT for pediatric minor TBI. The use of shielding and application of pediatric CT protocols constitute areas for improvement.
