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Study: Unconsciousness Shouldn’t Trigger Child CT Head Scan

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Even loss of consciousness from a blow to the head is not by itself reason enough to give a child a cranial CT scan, according to research published online Monday in JAMA Pediatrics.

Nathan Kuppermann, MD, senior author of the article and principal investigator for the Pediatric Emergency Care Applied Research Network (PECARN), from which the article’s data and analysis were derived, summarized the research this way:

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. Our findings can help doctors confidently make a decision to forgo 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.

Dr. Kuppermann is professor and chair of emergency medicine at the University of California, Davis. He was quoted in a UC Davis news release.

Whether to expose children to ionizing radiation has received increasing attention because of the risk of 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 child is warranted after blunt head trauma. The bottom line: children with loss of consciousness but no other predictors of clinically important traumatic brain injury (TBI) had a very low rate of such injuries—0.5 percent.

“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,” said Lois K. Lee, MD, director of trauma research at Boston Children’s Hospital and lead author of the JAMA Pediatrics article.

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Use of a simple diagnostic algorithm for children suspected of having acute appendicitis can cut the use of imaging in half, according to a new study. For details, see our Facebook page.

Related CME seminar (up to 27 AMA PRA Category 1 credits™): Pediatric Radiology

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