Observing Children With Head Injury Reduces CT Scan Use

Clinically important traumatic brain injury rate similar in observed and non-observed children

MONDAY, May 9 (HealthDay News) -- Clinical observation is associated with reduced computed tomography (CT) use among children with minor blunt head trauma, according to a study published online May 9 in Pediatrics.

Lise E. Nigrovic, M.D., M.P.H., from Harvard Medical School in Boston, and colleagues investigated the impact of observing children in the emergency department before deciding whether to use CT. Case report forms were completed for 40,113 children with minor blunt head trauma indicating whether or not they were observed before making a decision about CT use. Measured outcomes were rate of CT use and frequency of clinically important traumatic brain injury, defined as an intracranial injury resulting in death, neurosurgical intervention, intubation for longer than 24 hours, or hospital admission for two nights or longer. A generalized estimating equation model was used to compare CT rates between children who were observed and those who were not observed, and results were controlled for hospital clustering and patient characteristics.

The investigators found that 14 percent (5,433) of children were observed before making a decision on CT use. Children who were observed had a significantly lower CT use rate compared with those who were not observed (31.1 versus 35.0 percent, difference: −3.9 percent), but a similar rate of clinically important traumatic brain injury (0.75 versus 0.87 percent; difference: −0.1 percent). The difference in CT use remained significant between the groups, even after adjusting for hospital and patient characteristics, with the observed group having an adjusted odds ratio of 0.53.

"Clinical observation before making a decision regarding CT scan use seems to be a safe and potentially effective strategy to manage a subset of children with minor blunt head trauma," the authors write.

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