A strategy to optimize CT use in children with mild blunt head trauma utilizing clinical risk stratification; could we improve CT use in children with mild head injury?

Abstract

Aim: The purpose of our study was to investigate the impact of clinical risk classification on optimization of the rationale of CT scanning in children with mild blunt head trauma. Exposed effective radiation dose values of CT scanning were also evaluated.

Methods: Children with isolated pediatric mild head trauma admitted in a single center over a 5-year period (n=3102, >2 years and <16 years of age) were retrospectively reviewed. The study group comprised 806 patients with a mean age of 7.4±2.1 years (range, 2-15 years). The patients were categorized into low and high risk groups with regard to presence of predefined signs and symptoms. Effective radiation dose values were calculated.

Results: Incidences of the pathologic CT findings related to trauma were significantly different between low (n=10) 1.9% and high (n=90) 29.8% risk groups. Certain predefined signs and symptoms (e.g., vomiting, suspected skull fracture and loss of consciousness) were related significantly with pathologic CT findings attributed to trauma. Estimated mean effective dose values were 3.91±0.38mSv for 2-6 year old (n=557), and 3.33±0.12mSv for 7-16 year old patients (n=349).

Conclusion: The pediatric victims of mild head trauma patients within high risk group and those with vomiting, suspected skull fracture and loss of consciousness should undergo head CT scanning. The manufacturer settings on the CT scanners for children should be revised to alleviate untoward radiation exposure.

Keywords: Computed tomography; Head trauma; Pediatric; Radiation dosage.