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Young children with a minor traumatic head injury: clinical observation or CT scan?
Nicky Niele1,2, Frans B Plötz3,4, Ellen Tromp5
1Department of Pediatrics, Tergooi Hospital, Blaricum, The Netherlands. n.niele@amsterdamumc.nl.
Insights
Clinicians often choose clinical observation over CT scans for children with minor traumatic head injuries (MTHI) in the intermediate-risk group. Factors like older age, loss of consciousness, and weekend presentation influence the decision for a CT scan.
Area of Science:
- Pediatric Emergency Medicine
- Radiology
- Clinical Decision Making
Background:
- Clinical decision rules guide the management of pediatric minor traumatic head injuries (MTHI).
- In the Netherlands, up to 50% of children under 6 with MTHI may be classified as intermediate risk (IR), allowing clinicians to choose between observation and CT scans.
Purpose of the Study:
- To analyze clinician choices between clinical observation and CT scans for intermediate-risk MTHI patients.
- To identify factors associated with the decision to perform a CT scan in this patient group.
Main Methods:
- A planned sub-study of a prospective, multicenter observational study.
- Enrolled 1006 children under 18 with MTHI across six emergency departments.
- Focused on 280 children classified as intermediate risk.
Main Results:
- 81% of intermediate-risk children were managed with clinical observation.
- Only 5.4% received a CT scan, while 11% were discharged without intervention.
- CT scans were associated with older age (>2 years), any loss of consciousness, and weekend presentation.
Conclusions:
- Clinicians predominantly prefer clinical observation for intermediate-risk MTHI patients.
- Age, loss of consciousness, and day of presentation are key factors influencing the decision for CT scans in pediatric MTHI.
Abstract:
Currently, in young children with minor traumatic head injuries (MTHI) classified as intermediate risk (IR), PECARN recommends clinical observation over computer tomography (CT) scan depending on provider comfort, although both options being possible. In this study, we describe clinicians' choice and which factors were associated with this decision. This was a planned sub-study of a prospective multicenter observational study that enrolled 1006 children younger than 18 years with MTHI who presented to six emergency departments in The Netherlands. Of those, 280 children classified as IR group fulfilling one or more minor criteria, leaving the clinician with the choice between clinical observation and a CT scan. In our cohort, 228/280 (81%) children were admitted for clinical observation, 15/280 (5.4%) received a CT scan, 6/280 (2.1%) received a CT scan and were admitted for observation, and 31/280 (11%) children were discharged from the emergency department without any intervention. Three objective factors were associated with a CT scan, namely age above 2 years, the presence of any loss of consciousness (LOC), and presentation on weekend days.
Conclusion:
In children with MTHI in an IR group, clinicians prefer clinical observation above performing a CT scan. Older age, day of presentation, and any loss of consciousness are factors associated with a CT scan.
What Is Known:
• Clinical decision rules have been developed in the management of children of different risk groups with minor traumatic head injury (MTHI). • According to the Dutch national, clinical decision rules in children under 6 years of age up to 50% of children classify as intermediate risk (IR) and clinicians may choose between clinical observation and computed tomography (CT).
What Is New:
• In this IR group, clinical observation is chosen in 81% children with MTHI. • In the subgroup where clinicians performed a CT scan, children were older and presented more frequently on a weekend day, and more frequently consciousness was lost.
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