Observing children with blunt head trauma for a longer time period translates into a smaller chance they'll be scanned with CT, according to a new study published online August 5 in Annals of Emergency Medicine.
Dr. Lise Nigrovic and colleagues from Boston Children's Hospital found that every hour of observation time in the emergency department was associated with a lower head CT rate, and the association held together whether the patient was at low, intermediate, or high risk of head injury.
In the study, 49% of the 1,381 enrolled children with minor blunt head trauma were observed prior to head CT. Symptoms improved for most children during the observation period.
Each hour of observation reduced CT use by approximately 70% for all groups, categorized by risk:
- High-risk children had an adjusted odds ratio (OR) of 0.11
- Intermediate-risk children had an adjusted OR of 0.28
- Low-risk kids had an adjusted OR of 0.47
At the same time, observation prior to CT decision-making did not lead to an observed delay in the diagnosis of significant brain injury. All eight patients with significant brain injury underwent immediate CT.
Physicians must balance the chance of missing a clinically significant traumatic brain injury with the risk of future malignancy associated with ionizing radiation, Nigrovic said in a statement. Observation prior to scanning could significantly improve the care of children with minor blunt head trauma, she added.
