[Mild traumatic brain injury in children: can we reduce the number of CT-scans?]

Area of Science:

• Pediatric Emergency Medicine
• Neurotrauma Research
• Clinical Guideline Evaluation

Context:

• Mild traumatic brain injury (mTBI) management in children often follows strict national guidelines.
• Evaluating deviations from these guidelines is crucial for optimizing care and resource allocation.
• Isala emergency department data from December 2018 to July 2022 provides a relevant patient cohort.

Purpose:

• To assess the safety and outcomes of a more conservative, expectative management approach for pediatric mTBI compared to current guidelines.
• To determine the rates of hospital admission, CT scans, intracranial hemorrhage, and neurosurgical interventions in children with mTBI.
• To evaluate adherence to the national mTBI guideline in a real-world clinical setting.

Summary:

• A retrospective chart review included 704 children (0-18 years) with mTBI.
• Hospital admissions and CT scans were performed in 67.5% and 6.7% of cases, respectively.
• Intracranial hemorrhage occurred in 1.8% of patients, with 0.3% requiring neurosurgical intervention. Guideline adherence was only 34.5%.

Impact:

• Findings suggest that an expectative approach, even without initial imaging, is safe for pediatric mTBI.
• This approach can potentially reduce healthcare costs and patient exposure to radiation from CT scans.
• Highlights the need for guideline revision or improved adherence strategies in pediatric head injury management.