Unnecessary Scans Lead to Unnecessary Re-scans: Evaluating Clinical Management of Low and Intermediate Risk Pediatric...

Area of Science:

• Pediatric Emergency Medicine
• Radiology
• Neurotrauma

Background:

• The Pediatric Emergency Care Applied Research Network (PECARN) guidelines aim to identify children with mild head trauma at high risk for clinically important traumatic brain injury (ciTBI).
• Failure to adhere to PECARN criteria can lead to unnecessary radiation exposure, increased healthcare costs, and prolonged hospital stays.
• This study evaluates resource allocation for low and intermediate-risk pediatric patients who received head CTs not indicated by PECARN guidelines but revealed injuries.

Purpose of the Study:

• To assess the clinical significance and resource utilization of head CTs performed in pediatric patients who did not meet PECARN criteria for mild head trauma.
• To determine if initial head CT findings in low and intermediate-risk groups necessitate further imaging or intervention.

Main Methods:

• Retrospective cohort study of children aged 16 years or younger with head injuries (GCS ≥14) between 2016 and 2021.
• Exclusion criteria included neurological deficits, penetrating trauma, anticoagulation, or non-accidental trauma.
• Data collected included demographics, imaging results, PECARN risk category, and need for neurosurgical intervention.

Main Results:

• Of 70 low-risk patients with positive CT findings, none experienced clinically significant progression requiring intervention.
• Among 319 intermediate-risk patients with skull fractures or intracranial injuries on CT, only one required intervention based on clinical changes, not imaging.
• Repeat imaging did not influence clinical management decisions.

Conclusions:

• Cross-sectional imaging, particularly head CTs, is frequently overused in pediatric head trauma cases, even when PECARN guidelines are not met.
• Identifying small, clinically non-actionable intracranial bleeding often leads to further imaging without clear benefit.
• Routine interval imaging is likely unnecessary for neurologically stable children with low-risk head injuries.