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Cranial Computed Tomography Use in Pediatric Head Trauma: Assessing Appropriateness, Insights, and Recommendations in
Marley Blommers1, Minwoo Park2, Jessica Kimber2,3
1Faculty of Medicine, Dalhousie University, Halifax, NS, Canada.
Insights
Most after-hours pediatric head CT scans in the ED are normal, especially in older children. Younger children (<2 years) had a higher diagnostic yield for skull fractures and intracranial injuries.
Area of Science:
- Pediatric Emergency Medicine
- Radiology
- Trauma Surgery
Background:
- Acute head trauma (AHT) is a frequent reason for pediatric emergency department (ED) visits.
- Most AHT cases do not result in clinically important traumatic brain injury (ciTBI).
- Cranial computed tomography (CT) is often overused, leading to concerns about radiation exposure and resource utilization.
Purpose of the Study:
- To evaluate after-hours CT utilization patterns for pediatric head trauma.
- To assess the diagnostic yield of these CT examinations.
- To inform quality improvement initiatives and local imaging pathways.
Main Methods:
- Retrospective review of non-contrast cranial CT scans for children (<16 years) with head trauma.
- Data collected: skull fracture, intracranial injury (ICI), radiation dose, follow-up imaging.
- Patients grouped by age: <2 years and ≥2 years.
Main Results:
- 74% of 361 after-hours CT scans were normal.
- No skull fracture in 79.8% and no acute ICI in 83.9%.
- Children <2 years showed higher positive findings (34% skull fracture, 24.7% ICI).
Conclusions:
- After-hours ED-initiated cranial CTs for pediatric head trauma often lack acute findings, particularly in children ≥2 years.
- Younger children (<2 years) had a higher diagnostic yield from CT scans.
- Findings highlight institutional CT utilization patterns and potential areas for optimization.
Background/Objectives:
Acute head trauma (AHT) is a common reason for pediatric emergency department (ED) visits, although most cases do not result in clinically important traumatic brain injury (ciTBI). Clinical decision rules such as PECARN can help identify children at risk for ciTBI and guide the need for cranial computed tomography (CT). Despite this, CT appears frequently overused, raising ongoing concerns about radiation exposure, resource utilization, and clinical yield. This study evaluated after-hours CT utilization patterns and diagnostic yield for pediatric head trauma at a tertiary care centre.
Methods:
We conducted a retrospective review of after-hours non-contrast cranial CT examinations for pediatric (<16 years) head trauma performed between January 2020 and February 2024. Data extracted included presence of skull fracture and/or intracranial injury (ICI; bleed, contusion, or combination), radiation dose, and follow-up imaging. Patients were grouped by age (<2 and ≥2 years).
Results:
Among 361 children (median age 6 years; 150 females), 267 examinations (74%) were normal, with no evidence of skull fracture (79.8%) or acute ICI (83.9%). Only 29 cases (8%) underwent follow-up imaging. Children <2 years (n = 97) demonstrated higher rates of positive findings: 34% (33/97) had skull fractures and 24.7% (24/97) had ICI.
Conclusion:
In this cohort of after-hours ED-initiated cranial CT examinations, most studies did not demonstrate acute traumatic findings, particularly in children ≥2 years. Imaging of younger children had a comparatively higher diagnostic yield. These findings describe institutional CT utilization patterns and may inform future quality improvement initiatives and local imaging pathways.
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