Postponing CT scans may be safe for some child head injuries: study

NEW YORK Mon May 9, 2011 10:58pm EDT

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NEW YORK May 10 (Reuters Life!) - Observing some children after a head injury may help reveal which ones need a computed tomography (CT) scan and which ones don't, enabling many to avoid the radiation of an unnecessary test, according to a U.S. study.

This is particularly true for children who have some risk of a serious brain injury, but aren't showing serious symptoms, said Lise Nigrovic at Children's Hospital, Boston, who worked on the study.

If a child shows up at an emergency room very soon after a head injury, "you may just not have had enough time for symptoms to develop," she told Reuters Health.

Or a child "may have some symptoms that make you a little concerned, but you just want a little time."

Nigrovic and her colleagues reviewed data on over 40,000 children with a head injury who were taken to one of 25 different emergency rooms.

The original data had been collected by the Pediatric Emergency Care Applied Research Network, with chart notes showing whether each child was admitted for observation before doctors decided whether or not to perform a CT scan.

About 5,400, or 1 in 7, were observed. They were less likely to get a CT scan, 31 percent against 35 percent when doctors made that decision right away.

In both groups, fewer than 1 percent had a serious head injury.

Twenty-six children who were observed and sent home without a CT scan came back later for an x-ray. One of those children did end up having a positive scan.

The researchers concluded that observing some children before making the decision about a CT scan might be a safe and effective way of cutting back on scans, giving the example of a child who fell off a swing, had a headache and vomited once, but were awake and talking two hours after the injury.

"We all want to make sure that we use CT scanning in the cases where it's likely to be positive and that we save children from the radiation for those that we know are very unlikely to be positive," said Martin Osmond, at the Children's Hospital of Eastern Ontario, who had no ties to the study.

"This study adds important new information about who to observe."

But he added that a few questions remain, such as how long it makes sense to observe children before deciding whether to do a CT scan or send them home. There are also questions about how safe it is to put off such a scan, which will need to be the focus of future research.

SOURCE: bit.ly/l8JDYM (Reporting by Genevra Pittman at Reuters Health; editing by Elaine Lies)

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