Allowing a longer period of observation for a child with a head injury in the emergency department before deciding whether a brain scan is necessary reduces the use of such scans and may protect children from unnecessary radiation exposure, according to a study published in the Annals of Emergency Medicine yesterday.
The growing use of computed tomography (CT) scans among children has raised concerns that such scans may be exposing children to harmful levels of radiation. A recent study highlighted by news@JAMA found that CT scan rates had increased by 2 to 3 times among various age groups between 1996 and 2005. These concerns have led to calls for more judicious use of CT scans in children.
In the latest study, researchers studied whether choosing to wait and observe a child with a head injury would reduce use of CT scans. The team enrolled 1381 patients who presented with head injuries at Boston Children’s Hospital and found that every additional hour of observation reduced the likelihood that a child would receive a CT scan. Ultimately, about half the children were observed in the emergency department, about a third were sent home without observation, and 17% received an immediate CT scan.
The patients who were observed were monitored in the emergency department for an average of 4 hours, but the authors note that the optimal time for observation is not clear. They said that large multicenter trials are necessary to confirm their results.
Recent recommendations from the American Academy of Pediatrics (AAP) suggest that observation or another evaluation tool should be used in the initial evaluation of a minor head injury in a child.
“Clinical observation prior to CT decision-making for children with minor head injuries is an effective approach,” according to the AAP.