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Head CT Usually Not Necessary for Children Presenting With mTBI

Usually, a head CT is not necessary for diagnostic purposes in children with mild traumatic brain injury (mTBI), according to new guidelines from the CDC. Instead, these recommendations suggest clinicians use validated clinical decision rules to identify children with mTBI at low risk for intracranial injury (ICI), as well as those at higher risk for the condition who require a head CT.

A systematic literature review resulted in 19 sets of recommendations on diagnosis, prognosis, and management/treatment of pediatric mTBI. The guideline authors provide advice on cognitive testing, imaging, and symptom scales, as well as a standardized assessment for diagnosis. Further, the guidelines include advice on assessment, monitoring, counseling, and setting timetables for a return to normal activities after an injury.

The authors of the report noted that while ED visits for mTBI increased over the last decade, no evidence-based clinical guidelines existed in the United States. From 2005 to 2009, care was sought for children with mTBI in more than 2 million outpatient visits and almost 3 million ED visits. Often, ED staff use terms such as “concussion,” “minor head injury,” and “mild traumatic brain injury” interchangeably. However, guideline authors stress that such practice can cause confusion and misdiagnosis. Thus, moving forward, the guidelines call for using only “mild traumatic brain injury.”