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Cranial CT yield and predictors in children aged 0-36 months with head trauma
Mert Gültekin1, Cuma Önder Yeşildağ1, Ferit Gül1
1Department of Emergency Medicine, Şanlıurfa Training and Research Hospital, 63200 Şanlıurfa, Türkiye.
Insights
Cranial computed tomography (CT) scans are normal in most young children with head trauma. Clinical deterioration, scalp hematoma, and vomiting are key indicators for pathological CT findings in pediatric head trauma.
Area of Science:
- Pediatric Emergency Medicine
- Radiology
- Neurotrauma
Background:
- Cranial computed tomography (CT) is widely used for diagnosing head trauma in young children.
- However, its diagnostic utility may be limited without clear clinical risk factors, prompting investigation into predictive indicators.
Purpose of the Study:
- To evaluate cranial CT findings in children aged 0-36 months presenting with head trauma.
- To identify clinical predictors associated with pathological CT findings in this pediatric population.
Main Methods:
- A retrospective observational study analyzed 1434 children (0-36 months) who underwent cranial CT for head trauma.
- Clinical variables including scalp hematoma, vomiting, and trauma mechanism were assessed.
- Multivariable logistic regression and ROC analyses identified predictors of pathological CT findings.
Main Results:
- Most (92.2%) cranial CT scans were normal; pathological findings were present in 7.8% of cases.
- Pathological findings were more common in symptomatic infants and those younger than 12 months.
- Independent predictors of pathological CT findings included clinical deterioration (OR: 20.22), scalp hematoma (OR: 11.29), and vomiting (OR: 3.73).
Conclusions:
- Cranial CT scans reveal normal findings in the majority of young children with head trauma.
- Clinical deterioration, scalp hematoma, and vomiting are significant predictors that can guide more selective neuroimaging decisions in pediatric head trauma evaluations.
Introduction:
Cranial computed tomography (CT) is frequently used in young children with head trauma, although its diagnostic yield may be limited without specific clinical risk factors. This study evaluated cranial CT findings and clinical predictors of pathological CT findings in children aged 0-36 months presenting to the emergency department with head trauma.
Methods:
This retrospective observational study included 1434 children aged 0-36 months who presented with head trauma and underwent cranial CT between January 1 and December 31, 2022. Clinical variables included scalp hematoma, scalp laceration, vomiting, clinical deterioration during observation, and trauma mechanism. The primary outcome was pathological cranial CT findings. Multivariable logistic regression and receiver operating characteristic analyses were performed.
Results:
The median age was 1 year, and falls accounted for 97.8% of injuries. CT findings were normal in 92.2% of patients, while pathological findings were detected in 7.8%. Pathological CT findings were more frequent in symptomatic than asymptomatic patients (18.4% vs. 2.4%; p < 0.001) and in infants younger than 12 months compared with children aged 12 months or older (11.7% vs. 5.6%; p < 0.001). Clinical deterioration (OR: 20.22; 95% CI: 8.86-46.13), scalp hematoma (OR: 11.29; 95% CI: 7.05-18.06), and vomiting (OR: 3.73; 95% CI: 1.87-7.43) were independent predictors of pathological CT findings. The multivariable model showed good discrimination (area under the curve: 0.841; sensitivity: 76.8%; specificity: 83.5%).
Conclusion:
Cranial CT findings were normal in most imaged children aged 0-36 months with head trauma. Clinical deterioration, scalp hematoma, and vomiting may support more selective neuroimaging decisions.
