Observation After Head Injury Cuts Kids’ CT Scans
Study Shows Advantages of Postponing CT Scans in Emergency Rooms
Observation vs. CT Scan continued...
Of the 5433 children in the observation group, 3,744 (69%) were sent home without a scan. Of those, 26, (0.7%) returned later to have one. And of those, four children had traumatic findings on the scan, but only one had a clinically important injury. That child was hospitalized for two nights.
Of the 34,680 children in the non-observed group, 22,532 (65%), were sent home without a CT scan. Of those, 81 (0.4%) returned for a CT scan. And of these, three had traumatic findings but none had a clinical important injury.
Of a head CT scan, Nigrovic says: "It's an incredibly valuable tool when used on the appropriate patient."
However, experts must weigh the long-term risks of the radiation.
The estimates of how great this risk is differ. However, experts know children are at greater risk than adults. Their tissues are more radiosensitive. And they have a longer life expectancy and so a longer time during which radiation-induced cancer could develop.
When a head injury is clearly severe, a child will get a CT scan without the observation period, of course, says Donald Frush, MD, chair of the American College of Radiology Pediatric Imaging Commission. He reviewed the findings for WebMD but was not involved in the study.
But for minor head trauma, he says, "observation is a reasonable strategy." Frush is also chair of pediatric radiology at Duke University Medical Center in Durham, N.C.
The study, he says, supports the concept of observation in these cases.
If a CT scan is deemed necessary, he says, parents should know that the dose provided by a single CT scan to the brain of a child is roughly equal to six months to a year of ''background radiation."
He defines that as ''radiation we get from naturally occurring radioactive substances in the soil, and cosmic radiation -- from the heavens."
The radiation from a head CT, he says, ''can be as low as a few dozen chest X-rays to just over 100 chest X-rays. One chest X-ray is worth just a few days of background radiation.''