Anyone brought to a medical professional for mild head trauma undergoes a fairly standard process. First, the will answer a barrage of questions about how their injury occurred and what their current symptoms are. Then, they are likely to run through a few tests of motor function, before finally being sent off for a CT scan.
But experts are now saying CT scans should not be automatically given to children who come to emergency rooms with head trauma – especially if they are at low risk for significant brain injury.
Computed tomography (CT) scans are considered the standard method for determining if a life-threatening problem such as bleeding in the brain has resulted from a brain injury and needs surgery, however the radiation carries a small but quantifiable long-term risk of cancer.
Using a nationwide study of more than 40,000 children evaluated in hospital emergency departments for head trauma, researchers found that children who experience isolated loss of consciousness but no other symptoms of brain trauma are highly unlikely to have suffered brain injuries severe enough to warrant brain scans, as reported in JAMA Pediatrics.
“Fear of missing a clinically significant head injury, and the wide availability of CT scanners, have been the main factors driving an increase in the use of CT imaging over the past two decades,” says Nathan Kuppermann, professor of emergency medicine at University of California, Davis, and principal investigator of the original study from which the data and current analysis of head injuries were derived.
“Our findings can help doctors confidently make a decision to forego CT testing when their patients are unlikely to benefit from it, enabling physicians to first observe their patients for a period of time before deciding on CT use.”
The study specifically states that children who lose consciousness after head trauma, but are awake and aware in the emergency department and showed none of the other five factors determined to be important by PECARN guidelines for identifying children at low risk for clinically significant brain injuries after head trauma.
“Children with clinically important brain injuries rarely have loss of consciousness alone, and almost always present other symptoms, such as vomiting or showing signs of neurological problems,” says Lois K. Lee, lead author of the current study and director of trauma research at Boston Children’s Hospital. “Being able to make treatment decisions backed by strong data helps doctors and parents feel better about deciding whether further testing is really needed.”
Rather than subject children to low-doses of radiation, the researchers are using their findings to encourage doctors to observe patients before sending them for CT scans. Typically, other signs such as nausea and vomiting appear within hours if a significant brain injury has occurred.
Fast response is typically considered a highly important part of a positive recovery from brain injury, the researchers have found that under these conditions it is safer to wait for other signs of significant brain injury rather than exposing children to radiation associated with CT scans and increased risks of cancer.