Advertisement

Pediatric Radiology

, 38:670 | Cite as

Pediatric head trauma: the evidence regarding indications for emergent neuroimaging

  • Nathan KuppermannEmail author
ALARA: BUILDING BRIDGES BETWEEN RADIOLOGY AND EMERGENCY MEDICINE

Abstract

Traumatic brain injury (TBI) is a leading cause of childhood death and disability worldwide. In the United States, childhood head trauma results in approximately 3,000 deaths, 50,000 hospitalizations, and 650,000 emergency department (ED) visits annually. Children presenting to the ED with seemingly minor head trauma account for approximately one-half of children with documented TBIs. Despite the frequency and importance of childhood minor head trauma, there exists no highly accurate, reliable and validated clinical scoring system or prediction rule for assessing risk of TBI among those with minor head trauma. At the same time, use of CT scanning in these children in recent years has increased substantially. The major benefit of CT scanning is early identification (and treatment) of TBIs that might otherwise be missed and result in increased risk of morbidity and mortality. Unnecessary CT imaging, however, exposes the child needlessly to the risk of radiation-induced malignancies. What constitutes appropriate criteria for obtaining CT scans in children after minor blunt head trauma remains controversial. Current evidence to guide clinicians in this regard is limited; however, large studies performed in multi-center research networks have recently been conducted. These studies should provide the foundation of evidence to guide CT decisions by clinicians, help identify TBIs in a timely fashion, and reduce unnecessary radiation exposure.

Keywords

Traumatic brain injury Blunt head trauma Pediatric trauma Radiation exposure 

References

  1. 1.
    National Center for Health Statistics, Centers for Disease Control and Prevention (2000) National Hospital Ambulatory Medical Care Survey, Emergency Department File (2002); CD-ROM Series 13, No. 33Google Scholar
  2. 2.
    National Center for Injury Prevention and Control (2002) Traumatic brain injury in the United States: assessing outcomes in children. Centers for Disease Control and PreventionGoogle Scholar
  3. 3.
    Blackwell CD, Gorelick M, Holmes JF et al (2007) Pediatric head trauma: changes in use of computed tomography in emergency departments in the United States over time. Ann Emerg Med 49:320–324PubMedCrossRefGoogle Scholar
  4. 4.
    Aitken ME, Herrerias CT, Davis RL et al (1998) Blunt head injury in children. Arch Pediatr Adolesc Med 152:1176–1180PubMedGoogle Scholar
  5. 5.
    Klassen TP, Reed MH, Stiell IG et al (2000) Variation in utilization of computed tomography scanning for the investigation of minor head trauma in children: a Canadian experience. Acad Emerg Med 7:739–744PubMedCrossRefGoogle Scholar
  6. 6.
    Dietrich AM, Bowman MJ, Ginn-Pease ME et al (1993) Pediatric head injuries: can clinical factors reliably predict an abnormality on computed tomography? Ann Emerg Med 22:1535–1540PubMedCrossRefGoogle Scholar
  7. 7.
    Schunk JE, Rodgerson JD, Woodward GA (1996) The utility of head computed tomographic scanning in pediatric patients with normal neurologic examination in the emergency department. Pediatr Emerg Care 12:160–165PubMedCrossRefGoogle Scholar
  8. 8.
    Quayle KS, Jaffe DM, Kuppermann N et al (1997) Diagnostic testing for acute head injury in children: when are head computed tomography and skull radiographs indicated? Pediatrics 99:e1–e8CrossRefGoogle Scholar
  9. 9.
    Greenes DS, Schutzman SA (1999) Clinical indicators of intracranial injury in head-injured infants. Pediatrics 104:861–867PubMedCrossRefGoogle Scholar
  10. 10.
    Schutzman SA, Barnes P, Duhaime AC et al (2001) Evaluation and management of children younger than two years old with apparently minor head trauma: proposed guidelines. Pediatrics 107:983–993PubMedCrossRefGoogle Scholar
  11. 11.
    Palchak MJ, Holmes JF, Vance CW et al (2003) Clinical decision rules for identifying children at low risk for intracranial injuries after blunt head trauma. Ann Emerg Med 42:493–506CrossRefGoogle Scholar
  12. 12.
    Oman JA, Cooper RJ, Holmes JF et al (2006) Performance of a decision rule to predict need for computed tomography among children with blunt head trauma. Pediatrics 117:e238–e246PubMedCrossRefGoogle Scholar
  13. 13.
    Brenner DJ (2002) Estimating cancer risks from pediatric CT: going from the qualitative to the quantitative. Pediatr Radiol 32:228–233PubMedCrossRefGoogle Scholar
  14. 14.
    Hall EJ (2002) Lessons we have learned from our children: cancer risks from diagnostic radiology. Pediatr Radiol 32:700–706PubMedCrossRefGoogle Scholar
  15. 15.
    Brenner DJ, Hall EJ (2007) Computed tomography—an increasing source of radiation exposure. N Engl J Med 357:2277–2284PubMedCrossRefGoogle Scholar
  16. 16.
    Davis RL, Mullen N, Makela M et al (1994) Cranial computed tomography scans in children after minimal head injury with loss of consciousness. Ann Emerg Med 24:640–645PubMedCrossRefGoogle Scholar
  17. 17.
    Palchak M, Holmes J, Vance C et al (2004) Does an isolated history of loss of consciousness or amnesia predict brain injuries in children after blunt head trauma? Pediatrics 113:e507–e513PubMedCrossRefGoogle Scholar
  18. 18.
    Haydel MJ, Shembekar AD (2003) Prediction of intracranial injury in children aged five years and older with loss of consciousness after minor head injury due to nontrivial mechanisms. Ann Emerg Med 42:507–514PubMedCrossRefGoogle Scholar
  19. 19.
    Dunning J, Daly JP, Lomas JP, for the CHALICE study group et al (2006) Derivation of the children’s head injury algorithm for the prediction of important clinical events decision rule for head injury in children. Arch Dis Child 91:885–891PubMedCrossRefGoogle Scholar
  20. 20.
    Jenny C, Hymel KP, Ritzen A et al (1999) Analysis of missed cases of abusive head trauma. JAMA 281:621–626PubMedCrossRefGoogle Scholar
  21. 21.
    Bechter K, Stoessel K, Leventhal JM et al (2004) Characteristics that distinguish accidental from abusive head injury in hospitalized young children with head trauma. Pediatrics 114:165–168CrossRefGoogle Scholar
  22. 22.
    Duhaime AC, Alario AJ, Lewander WJ et al (1992) Head injury in very young children: mechanisms, injury types, and ophthalmologic findings in 100 hospitalized patients younger than 2 years of age. Pediatrics 90:179–185PubMedGoogle Scholar
  23. 23.
    Hettler J, Greenes D (2003) Can the initial history predict whether a child with a head injury has been abused? Pediatrics 111:602–607PubMedCrossRefGoogle Scholar
  24. 24.
    Berger RP, Dulani T, Adelson PD et al (2006) Identification of inflicted traumatic brain injury in well-appearing infants using serum and cerebrospinal markers: a possible screening tool. Pediatrics 117:325–332PubMedCrossRefGoogle Scholar
  25. 25.
    Greenes DS, Schutzman SA (1997) Infants with isolated skull fracture: what are their clinical characteristics, and do they require hospitalization? Ann Emerg Med 30:253–259PubMedCrossRefGoogle Scholar
  26. 26.
    Greenes DS, Schutzman SA (2001) Clinical significance of scalp abnormalities in asymptomatic head-injured infants. Pediatr Emerg Care 17:88–92PubMedCrossRefGoogle Scholar
  27. 27.
    Mower WR, Hoffman JR, Herbert M et al (2005) Developing a decision instrument to guide computed tomographic imaging of blunt head injury patients. J Trauma 59:954–959PubMedCrossRefGoogle Scholar
  28. 28.
    Osmond MH, Klassen TP, Stiell IG et al (2006) The CATCH rule: a clinical decision rule for the use of computed tomography of the head in children with minor head injury. Acad Emerg Med 13:S11CrossRefGoogle Scholar
  29. 29.
    Kuppermann N, Holmes JF, Dayan PS, PECARN et al (2007) Blunt head trauma in the Pediatric Emergency Care Applied Research Network (PECARN). Acad Emerg Med 14:S94–S95CrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  1. 1.Department of Emergency MedicineUC Davis Medical CenterSacramentoUSA
  2. 2.Departments of Emergency Medicine and PediatricsUniversity of California, Davis School of MedicineDavisUSA

Personalised recommendations