Appropriateness of imaging requests for pediatric traumatic brain injury in the emergency department: a retrospective cross-sectional study

Esteban A Vásquez Carpio ^1,2, Belén Báez ³, Matías Huidobro ³

⁰INDISA Clinical Campus, Department of Radiology, School of Medicine, Universidad Andrés Bello, Av. Santa María 1810, Providencia, Santiago, Chile. esteban.avc@gmail.com.

Emergency Radiology +

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January 8, 2026

View abstract on PubMed

Summary

Pediatric traumatic brain injury (TBI) imaging requests in Chile were rarely appropriate, with most CT scans and all skull radiographs yielding no significant findings. Optimizing imaging use through decision tools can reduce unnecessary radiation exposure for children.

Area Of Science

Pediatric Radiology
Neurotrauma Imaging
Healthcare Quality Improvement

Background

Pediatric traumatic brain injury (TBI) is a common emergency department visit cause.
Current clinical guidelines are often bypassed, leading to overuse of neuroimaging in children, particularly for mild TBI.
There is limited data on imaging request appropriateness and diagnostic value in Latin America.

Purpose Of The Study

To evaluate the appropriateness of imaging requests (AIR) for pediatric TBI.
To determine the association between AIR and radiologic findings.
To identify predictors of diagnostic yield in pediatric TBI neuroimaging.

Main Methods

Retrospective, multicentric study of 719 neuroimaging studies (CT, skull radiography) in Santiago, Chile.
Appropriateness of imaging requests assessed using ACR Criteria and PECARN algorithm.
Multivariable analysis explored factors associated with final diagnoses.

Main Results

Only 2.9% of imaging requests were appropriate.
Appropriate CT scans had a 48% yield of confirmatory findings versus 7% for inappropriate ones.
Skull radiographs showed a 1% diagnostic yield, with all requests deemed inappropriate.

Conclusions

A substantial discrepancy exists between clinical practice and established guidelines for pediatric TBI imaging in Chile.
Implementing validated decision support tools can improve imaging appropriateness.
Optimizing neuroimaging use minimizes radiation exposure and healthcare costs for pediatric TBI.

Keywords:

Appropriate Brain injuries, Child; Emergency service, Hospital; Radiography; Tomography, Traumatic; X- ray computed;