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Child's Nervous System

, Volume 17, Issue 4–5, pp 257–262 | Cite as

International study of emergency department care for pediatric traumatic brain injury and the role of CT scanning

  • A. Murgio
  • Peter D. Patrick
  • F. A. Andrade
  • S. Boetto
  • K. M. Leung
  • M. A. Muñoz Sanchez
Original Paper

Abstract 

Objects: Our objective was to investigate the use of CT and its relationship to head injury severity and age. Method: The multi-center group International Study of Head Injury Project (ISHIP) serves as the administrative body for research design, data collection and analysis. This is a nonrandomized prospective study of longitudinal outcomes following examination and care in emergency department in five different countries. The subjects of our study were 4,690 children from birth to 15 years of age, all of whom were systematically evaluated. Each child was medically evaluated and categorized as to injury severity, mechanism of injury and findings on X-ray and CT scan. Follow-up interview and assessment was completed for comparison with the presenting clinical state. Results: CT scans were performed for674 (14.3%) of the children: 438 scans were normal and 236 were abnormal (P<0.001). Of the children with abnormal CT scans, 23.3% had mild head injuries, 42.7% had moderate injuries, and 33.8% had severe injuries, as determined by the GCS. By age, 10.5% of the positive CTs were in children aged 0–2 years, 56.3% in 3- to 9-year-olds, and 33% in 10- to 15-year-olds; only in 2% of cases were both CT and X-ray positive. Conclusions: The majority of children did not need significant medical intervention. Physicians ordered X-ray investigations more frequently than CT scanning. The use of X-ray to decide whether or not CT is ne- cessary is not warranted. The implications of positive CTs in mild or moderate injuries were most noteworthy, as were age-related interactions with positive CT findings.

Keywords Head injury Children CT scan Emergency department 

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Copyright information

© Springer-Verlag Berlin Heidelberg 2001

Authors and Affiliations

  • A. Murgio
    • 1
  • Peter D. Patrick
    • 2
  • F. A. Andrade
    • 3
  • S. Boetto
    • 3
  • K. M. Leung
    • 3
  • M. A. Muñoz Sanchez
    • 3
  1. 1.Quintana 1256, Mar del Plata (B7602GDZ), Argentina e-mail: Abel@statics.com.ar Tel.: +54-223-4518399 Fax: +54-223-4518399AR
  2. 2.Department of Pediatrics, School of Medicine, University of Virginia, Charlottesville, Virginia, USAUS
  3. 3.Emergency Department, Hospital Virgen del Rocio, Seville, SpainES

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