Brain CT scan for pediatric minor accidental head injury. An Italian experience and review of literature
Every year 300,000 children with accidental head trauma are admitted to Italian emergency departments. Our aims were: (1) to describe patients with minor traumatic brain injury who were admitted to pediatric departments and underwent CT, and (2) to analyze the appropriateness of management according to current guidelines.
We retrospectively analyzed patients with minor head injury (median age 4.5 years, range 1 month to 16 years) who were admitted to the pediatric department of the Catholic Medical School of Rome, from January 2005 to September 2010, who performed head CT. Univariate analysis was performed using the Fisher’s exact test. Multivariate analysis was performed by logistic regression.
One hundred and seventy-four patients were enrolled in the study. Fifty-four patients (31%) had pathological CT findings. Eight patients underwent neurosurgical treatments. Vomiting was the only symptom significantly prevalent in the infant group, compared to the children group (10.7% vs. 38.9%, p = 0.007), while loss of consciousness in the children group (50.0% vs. 25.0%, p = 0.040). The relationship between scalp swelling and CT abnormalities was statistically significant in the entire population. The incidence of head abnormalities was significantly higher in children with abnormal CT (92.6% vs. 72.5%).
The best way to manage children with minor head trauma is still matter of debate. Loss of consciousness and scalp swelling are risk factors predicting brain injury that deserve CT control. The radiation risks posed by CT scanning in children must be balanced by the benefits. We believe that even though CT scans may be clinically unnecessary in many cases, the rate of scanning is justified by the even limited number of abnormalities which require neurosurgical treatment.
KeywordsHead injury Brain CT scan Head injury guidelines Childhood
Conflict of interest
- 1.ISTAT (Italian National Institute of Statistics) 2000 (2004) Cause di morte (Causes of death). http://www.istat.it/Prodotti-e/Allegati1/Cause-di-m6/volumeII.pdf. Accessed 18 October
- 3.National Collaborating Centre for Acute Care (UK) (2007) Head Injury: Triage, Assessment, Investigation and Early Management of Head Injury in Infants, Children and Adults. London: National Collaborating Centre for Acute Care (UK)Google Scholar
- 7.SIGN (2009) Early management of patients with a head injury. A national clinical guideline. http://www.sign.ac.uk/pdf/sign110.pdf. Accessed Dec 2011
- 8.SIAARTI-SARNePI (2004) Guidelines for the management of severe pediatric head injury. Minerva Anestesiol 70:549–604Google Scholar
- 10.Osmond MH, Klassen TP, Wells GA, Correll R, Jarvis A, Joubert G, Bailey B, Chauvin-Kimoff L, Pusic M, McConnell D, Nijssen-Jordan C, Silver N, Taylor B, Stiell IG; Pediatric Emergency Research Canada (PERC) Head Injury Study Group. CATCH: a clinical decision rule for the use of computed tomography in children with minor head injury. CMAJ. 2010 Mar 9;182(4):341-8. Epub 2010 Feb 8.PubMedCrossRefGoogle Scholar
- 13.National Center for Injury Prevention and Control (2008) Traumatic brain injury. Atlanta: Centers for Disease Control and Prevention. http://www.cdc.gov/ncipc/tbi/TBI.htm. Accessed 17 April 2008
- 14.The Italian Office of the Health, the Italian institute of Statistic (ISTAT) (1999). Incidence of head injury by age segment of Italian population year. http://www.istat.it/. Accessed Dec 2011
- 24.Homer CJ, Kleinman L (2003) Technical report: minor head injury in children. Pediatrics 104:1–7Google Scholar