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Child Head CT Decision Gets More Complicated

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OK, is it a good idea to do cranial CT scans of children who have suffered head injuries or not? About 1 percent of the time, according to a new study, such scans reveal a serious but unrelated medical issue. Does that small chance of finding an unexpected problem outweigh earlier study results indicating that many such scans are unnecessary?

First, let’s look at the latest study, published online Monday in Pediatrics. The researchers looked at 15,831 children (younger than 18) who had undergone cranial CT scans after suffering blunt head trauma. Of those scans, 670 revealed problems unrelated to the injury that had triggered the scan. In 195 of those cases, the incidental finding was serious enough to warrant immediate intervention or outpatient follow-up.

The study authors wrote:

A small but important number of children evaluated with CT scans after blunt head trauma had incidental findings. Physicians who order cranial CTs must be prepared to interpret incidental findings, communicate with families, and ensure appropriate follow-up.

The authors also recognized pitfalls in taking those actions. A physician could tell the family about even clinically insignificant incidental findings. Such full disclosure might protect the physician in case of legal action but cause unnecessary anxiety and costs for the patients and their families.

The latest finding is just another factor to include in the “scan or not?” equation. Researchers and specialty practice organizations have suggested cutting back on CT scans of children’s heads in cases of dizziness (as we reported last month and in January 2012) and headache (as we reported last month). Studies have warned about an increased risk of cancer (as we reported in May) and suggested observing children first in the emergency department before sending them for CT scans (as we reported in May 2011).

In the real world, legal issues, worried parents, and the simple impulse to use available diagnostic tools to evaluate a possibly seriously injured child all tend to mitigate in favor of doing a scan. Maybe, this latest study indicates, that’s a good thing.

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One Response to “Child Head CT Decision Gets More Complicated”

  1. Radiology Daily»AlertArchive » Study: Unconsciousness Shouldn’t Trigger Child CT Head Scan on July 9th, 2014 at 1:10 pm

    […] future cancer. We’ve reported on other research about pediatric head CT scans, most recently here. The new study looked at loss of consciousness by itself as an indicator that a head CT scan of a […]