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Children presenting to the ED for evaluation of blunt head trauma is a common occurrence. But of these patients, very few will be diagnosed with significant traumatic brain injury. So, the question arises whether CT scan use in this population would be reduced by lengthening the time of observation prior to scan.
With the futre risk associated with radiation exposure and the costs of CT scans in mind, researchers out of Boston’s Children’s Hospital set out to see if a difference would be noted; the study is published online.1
The study enrolled 1381 children with minor blunt head trauma. Of these, emergency physicians observed approximately half (49%) prior to deciding whether to obtain CT scans. They found that every hour of observation reduced CTs by nearly 70%, and that the symptoms improved for most children during the period of observation.
“Every hour of observation time in the emergency department was associated with a decrease in CT rates for children whether at low, intermediate, or high risk of traumatic brain injury,” said lead study author Lise E. Nigrovic, MD, MPH, of Boston Children’s Hospital in Boston, Mass. “Furthermore, observation prior to CT decision-making for children with minor blunt head trauma was associated with reduced CT use without an observed delay in the diagnosis of significant traumatic brain injury.”
“As emergency physicians, we must balance the possibility of missing a clinically significant traumatic brain injury with the future risk of malignancy associated with ionizing radiation exposure,” said Dr. Nigrovic. “Observation prior to CT decision-making has the potential to further reduce CT rates without missing children with significant injuries, further improving the emergency care of children with minor blunt head injury.”
Reference 1. “Impact of the Duration of Emergency Department Observation on Computed Tomography Use in Children with Minor Blunt Head Trauma” http://tinyurl.com/kowyblr