Need for CT Scan in Head Trauma
Thomas F. Heyne
Lauren Allister
Identification of Children at Very Low Risk of Clinically-Important Brain Injuries After Head Trauma: A Prospective Cohort Study
Kuppermann N, Holmes JF, Dayan PS, et al. Lancet. 2009;374(9696):1160–1170
Background
Head trauma in children accounts for over 600,000 emergency department (ED) visits annually: approximately 2% of cases represent clinically important traumatic brain injury (ciTBI), defined as injury requiring acute intervention.1,2 Head CT was previously used especially in preverbal children unable to provide a history, but the ionizing radiation poses a long-term malignancy risk. Prior to this study, clinical prediction rules existed to identify adult patients most likely to benefit from head CT, but no such rules existed for children.
Objectives
To derive and validate age-specific clinical decision rules to identify children with blunt head trauma who are at very low risk for ciTBI.
Methods
Prospective cohort derivation and validation study in 25 US EDs within the Pediatric Emergency Care Applied Research Network (PECARN) from 2004 to 2006.
Patients
42,412 children ages <18 years presenting <24 hours after head trauma with Glasgow Coma Scale (GCS) scores of 14 to 15. Select exclusion criteria: low-risk injury mechanisms, penetrating trauma, pre-existing neurologic conditions, bleeding disorder, or ventricular shunt.
