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Don’t CT scan children with minor head injury, says study

If your child has lost consciousness and no more after a head injury, chances are that it is nothing serious and does not need a CT scan according to a study that involved 40,000 children evaluated in hospital emergency departments for head trauma. There is no need for children who suffer from isolated loss of consciousness following head trauma to go through a CT scan, the researchers from UC Davis Health System and Boston Children’s Hospital reported.

This is a significant finding since CT scans, standard way of checking if a child has life-threatening bleeding in the brain, carries a small but quantifiable long-term risk of cancer. The data shows that CT evaluation need not be resorted to among children with head trauma if they are at low risk for clinically significant traumatic brain injuries.

“Doctors have been increasingly using CT Scans owing to the fear of missing a clinically significant head injury as also because of the easy availability of CT scanners,” said Nathan Kuppermann, professor and chair of the UC Davis Department of Emergency Medicine. “Our findings can help doctors avoid CT testing among patients who are unlikely to benefit from it.”

The study found that only 1 in 200 of the children who passed out after head trauma but then were awake and alert in the emergency department showing no other symptom suffered from clinically important brain injuries. If a child had isolated loss of consciousness without any other signs or symptoms of head trauma the incidence of an important brain injury dropped to only 0.2 percent, or 1 in 500 children.

“Other than loss of consciousness, children with clinically important brain injuries invariably present other symptoms like vomiting or show signs of neurological problems,” said Lois K. Lee, lead author of the study and director of trauma research at Boston Children’s Hospital. “The ability to make treatment decisions based on strong data helps doctors and parents feel better about deciding whether further testing is really needed.” Better than rushing such children for a scan, it may be better to observe them in an emergency department for a few hours and see if any other signs or symptoms develop before deciding on a CT.

CT scans are associated with ionizing radiation, which are known to increase the risk of cancer. A single head CT scan for a child is equivalent to roughly 140 chest x-rays, according to “The Essential Physics of Medical Imaging.”

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