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Study: Watch Kids Before Ordering Head Scan

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Simply observing children taken to hospital emergency departments with possible head injuries before sending them for CT scans could cut the rate of such scans by as much as half without jeopardizing the children’s health, according to a study published online Monday by the journal Pediatrics (and freely available).

The researchers do not address the practicality of this advice in the real world, where both anxious parents and fears of malpractice suits hover.

The study, led by researchers from Children’s Hospital Boston and UC Davis, involved records of 40,113 children at 25 U.S. EDs. Of those children, 5,433 (less than 14 percent) were observed for varying periods of time before a decision was made about whether to send them for a CT scan. Among those “observed” patients, the rate of CT scans eventually ordered was significantly lower than for the patients who were not observed.

The study found that rates of clinically important traumatic brain injury were virtually identical between the two groups (0.75 percent for the observed, 0.87 percent for the nonobserved), indicating that waiting before deciding on a CT scan did not compromise safety.

“Only a small percentage of children with blunt head trauma really have something serious going on,” said study coleader Lise Nigrovic, MD. “If you can be watched in the ED for a few hours, you may not need a CT.”

Dr. Nigrovic is a pediatric emergency medicine specialist at Children’s Hospital and an assistant professor in pediatrics at Harvard Medical School. She was quoted in a Children’s Hospital news release.

Avoiding unnecessary CT scans, and the possible negative effects of ionizing radiation, is particularly crucial for children, who have more years than adults for those negative effects to manifest themselves. Said Dr. Nigoric:

CT isn’t bad if you really need it, but you don’t want to use it in children who are at low risk for having a significant injury. For parents, this means spending a couple of extra hours in the ED in exchange for not getting a CT.

Dr. Nigoric continued: “It’s the children in the middle risk groups—those who don’t appear totally normal, but whose injury isn’t obviously severe—for whom observation can really help.”

OK, but how many parents will quietly spend those “couple of extra hours” as the ED staff, from the parents’ viewpoint, seemingly does nothing to help their injured child? When news of this study was posted on Medical News Today, it drew the following comment from “Marc”:

“I suspect every ER physician and Radiologist (like myself) already knows this. What is not said is that these valid guidelines will never be truly implemented because of two factors:

“1. Risk of medical malpractice suits will preclude physicians from practicing ‘good medicine’ or ‘cost effective medicine’ in lieu of practicing ‘low risk’ medicine. Nobody will take the risk of missing a head bleed and getting sued.

“2. Our health care system puts a premium on productivity, including shorter ER visits. It’s far faster to get the CT than watch the kid for 4-6 hours. In addition, hospitals want the revenue.”

Related seminar: Emergency Radiology

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One Response to “Study: Watch Kids Before Ordering Head Scan”

  1. emedist.com on May 10th, 2011 at 12:00 pm

    Observation vs. CT for Head Injuries…

    Head injuries are common in childhood.From falling off bikes and collisions while playing football or soccer to toddlers who fall while learning to walk, some kids hit their heads so much you begin to wonder if they should wear a helmet all day long.Fo…