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Reasons for Ordering a Computed Tomography Scan and Abnormalities Found in Pediatric Intermediate-Risk Mild Head
Irene Ortiz-Santiago1, Nagore Ibarzabal-Segui1, Edurne López-Gutiérrez1,2
1Department of Pediatric Emergency, Biobizkaia Health Research Institute, Cruces University Hospital, Osakidetza, EHU, University of the Basque Country.
Insights
In children with intermediate-risk mild head trauma, factors influencing CT scan use differ from those predicting abnormalities. Vomiting, headache, and abnormal behavior increased CT scans, while younger age and severe injury mechanisms were linked to abnormalities.
Area of Science:
- Pediatric Emergency Medicine
- Radiology
- Trauma Care
Background:
- Mild head trauma is common in children.
- The PECARN rule stratifies risk, identifying intermediate-risk cases requiring careful evaluation.
- CT scans are frequently used but carry risks, necessitating judicious application.
Purpose of the Study:
- To investigate the determinants of CT scan utilization in pediatric intermediate-risk mild head trauma.
- To identify factors associated with CT-detected abnormalities in this cohort.
- To differentiate between reasons for imaging and findings.
Main Methods:
- Retrospective observational study of 555 children (3 months–14 years) with intermediate-risk mild head trauma.
- Analysis of demographic and clinical data from 2021–2022.
- Multivariable logistic regression to identify factors associated with CT scan use and abnormalities.
Main Results:
- CT scans were performed in 14.1% of patients, revealing abnormalities in 30.8% of those scanned.
- Clinically important traumatic brain injuries (ciTBI) were found in 1.1% of all patients.
- Factors associated with CT utilization included vomiting, headache, abnormal behavior, and delayed physician assessment.
- Younger age and severe injury mechanism predicted CT abnormalities.
Conclusions:
- CT scan utilization in intermediate-risk pediatric head trauma is driven by clinical symptoms and ED process factors, not solely by the likelihood of abnormalities.
- Findings suggest potential for refining CT decision-making criteria in this population.
- Further research is warranted to validate these distinct predictors.
Objective:
To analyze the reasons for ordering a CT scan and the abnormalities identified in children with mild head trauma classified as intermediate-risk according to the PECARN rule.
Methods:
This retrospective observational study included patients aged 3 months to 14 years who presented to the emergency department (ED) of a tertiary hospital between 2021 and 2022 with mild head trauma classified as intermediate-risk. Two multivariable analyses were performed to identify demographic and clinical factors associated with CT scan utilization and CT abnormalities.
Results:
We included 555 patients; 40% were girls, and the median age was 4 years (interquartile range: 1 to 8 y). Most patients (98.6%) were managed as outpatients after a median ED stay of 4.5 hours (IQR: 4 to 6.75). CT scans were performed in 78 patients (14.1%), of whom 24 (30.8%) had abnormalities: 13 had traumatic brain injuries and 11 had isolated skull fractures. Six patients (1.1%) had clinically important traumatic brain injuries (ciTBI). Four independent factors were associated with CT scan utilization: number of vomiting episodes (OR: 1.31; 95% CI: 1.16-1.49), headache (OR: 2.1; 95% CI: 1.21-3.6), abnormal behavior reported by parents (OR: 3.45; 95% CI: 1.99-5.95), and time elapsed before being seen by an ED physician (OR: 1.05; 95% CI: 1.01-1.08). Two factors were associated with CT abnormalities: younger age (OR: 0.82; 95% CI: 0.71-0.95) and severe injury mechanism (OR: 5.89; 95% CI: 2.04-18.37).
Conclusions:
In children with mild head trauma classified as intermediate-risk, the factors leading to CT scan utilization differ from those associated with CT abnormalities. Further studies are needed to confirm these findings.
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