Young children with a minor traumatic head injury: clinical observation or CT scan?

Abstract

Currently, in young children with minor traumatic head injuries (MTHI) classified as intermediate risk (IR), PECARN recommends clinical observation over computer tomography (CT) scan depending on provider comfort, although both options being possible. In this study, we describe clinicians’ choice and which factors were associated with this decision. This was a planned sub-study of a prospective multicenter observational study that enrolled 1006 children younger than 18 years with MTHI who presented to six emergency departments in The Netherlands. Of those, 280 children classified as IR group fulfilling one or more minor criteria, leaving the clinician with the choice between clinical observation and a CT scan. In our cohort, 228/280 (81%) children were admitted for clinical observation, 15/280 (5.4%) received a CT scan, 6/280 (2.1%) received a CT scan and were admitted for observation, and 31/280 (11%) children were discharged from the emergency department without any intervention. Three objective factors were associated with a CT scan, namely age above 2 years, the presence of any loss of consciousness (LOC), and presentation on weekend days.Conclusion: In children with MTHI in an IR group, clinicians prefer clinical observation above performing a CT scan. Older age, day of presentation, and any loss of consciousness are factors associated with a CT scan. What is Known:• Clinical decision rules have been developed in the management of children of different risk groups with minor traumatic head injury (MTHI).• According to the Dutch national, clinical decision rules in children under 6 years of age up to 50% of children classify as intermediate risk (IR) and clinicians may choose between clinical observation and computed tomography (CT). What is New:• In this IR group, clinical observation is chosen in 81% children with MTHI.• In the subgroup where clinicians performed a CT scan, children were older and presented more frequently on a weekend day, and more frequently consciousness was lost.

CT Scanning in Children in a Country with Limited Resources (Burkina Faso)

“…This examination is recommended in cases of persistent or worsening neurological disorders, focal neurological signs or obvious brain injury, to search for bone and brain lesions [12]. Some studies have shown, however, that other criteria that may influence the achievement of CT in the case of head-brain injury, namely an age greater than 2 years and the occurrence of trauma during the weekend [13].…”

Do astrocytes act as immune cells after pediatric TBI?

“…TBI severity in clinic has been classified as mild, moderate and severe using the patient’s level of consciousness measured by the Glasgow Coma Scale (GCS) ( McKee and Daneshvar, 2015 ). Adult patients presenting with low GCS scores and/or suspected intracranial hemorrhage, often undergo computed tomography (CT), but head CT scans in young children are prescribed with caution because of potential risks of ionizing radiation on developing brain ( Niele et al, 2022 ). Overall, TBI affects about three million children worldwide each year ( Dewan et al, 2016 ).…”

Multicentre study found no increased risk of clinically important brain injuries when children presented more than 24 h after a minor head trauma

“…The secondary outcomes were to compare the rate of traumatic brain injuries in the two groups and to identify factors that were potentially associated with the risk of clinically important traumatic brain injuries. Because PECARN states that there are only clear-cut indications for neuroimaging for high-risk patients, 7,16 we limited our analysis of the latter secondary outcome to high-risk patients.…”