Computed Tomography Scans in Children With Hemophilia After Minor Head Trauma
Alison Gardner1, Thomas W McLean2, James E Winslow3
1From the Departments of Pediatrics and Emergency Medicine.
Insights
Head CT scans for children with hemophilia after minor head trauma may not be necessary. This approach can reduce radiation exposure without missing intracranial hemorrhages.
Area of Science:
- Pediatric Hematology
- Radiology
- Neuroscience
Background:
- Children with hemophilia face typical childhood risks of falls and head injuries.
- Head computed tomographies (HCTs) are valuable diagnostic tools but pose risks of radiation-induced brain malignancy in pediatric patients.
Purpose of the Study:
- To evaluate the incidence of intracranial cerebral hemorrhage in pediatric hemophilia patients.
- To accurately weigh the risks and benefits of HCT utilization in this population.
Main Methods:
- Retrospective chart review of pediatric patients (0-15 years) with hemophilia.
- Analysis of head CT orders, total and per patient, and the incidence of positive findings (blood products).
Main Results:
- No intracranial cerebral hemorrhages or neurosurgical interventions were identified in the study cohort.
- Applying established head injury criteria could reduce HCT orders by approximately 80 scans (2 per child) without missing any hemorrhages.
Conclusions:
- Routine HCT for children with hemophilia and minor head trauma may not be indicated solely based on diagnosis.
- Imaging decisions should integrate clinical examination findings and neurological status to optimize risk-benefit balance.
Objectives:
Children with hemophilia have the usual childhood risk of falls and head trauma. Head computed tomographies (HCTs) are fast, detailed, and readily available, but increased radiation exposure in the pediatric population is now recognized as causing increased brain malignancy. By examining the incidence of intracranial cerebral hemorrhage in this population, we will be able to weigh risks and benefits of HCT use more accurately.
Methods:
Using a retrospective chart review, we examined past medical records of pediatric patients, aged 0 to 15 years, with hemophilia presenting to 1 academic medical center. Primary outcomes included number of head CTs ordered, total and per patient over the years studied, and the incidence of positive findings, as defined by presence of blood products as documented by radiologist final read/interpretation.
Results:
The mean number of head CTs per child was 2.5 (range, 1-10). None of the HCT scans were read as intracranial cerebral hemorrhage, and none of the patients had findings that lead to neurosurgical intervention. In a sensitivity analysis, applying Pediatric Emergency Care Applied Research Network head injury criteria, 11 HCT scans would be ordered for a reduction of 80 HCTs, or a decrease of 2 HCT scans per child. No incidence of intracranial cerebral hemorrhage would have been missed.
Conclusions:
Our findings suggest that in the child with hemophilia and a history of minor head trauma, exposure to the radiation of a HCT based on the diagnosis of hemophilia alone may not be necessary but that imaging decisions need to be made in conjunction with clinical examination findings and neurologic status.
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