Tuesday, April 13, 2010

But my kid bumped his head! I want a CT scan!!!

I wrote about this once before but I want to elaborate more.

I am at a pediatric emergency medicine conference and they presented a very interesting study about kids with low risk head injuries and the need for CT scan.

Here's the reference if you want to look it up
Kupperman N., Holmes JF, Dayan PS et al. Identification of children at very low risk of clinically important brain injuries after head traumaL a prospective cohort study. Lancet. 3 October 2009; 374(9696) 1160-70.

They looked at 42,412 children who had non severe mechanism of head injury. Kids who were younger than 2 who had no loss of consciousness or loss of consciousness for less than 5 seconds, no palpable skull fracture and acting normally per parents had a negative predictive value of 100% for traumatic brain injury. This means none of them had traumatic brain injury.

Kids older than 2 who had normal mental status, no loss of consciousness, no vomiting, non severe injury mechanism, no signs of skull fracture, no severe headache had a 99.95% negative predictive value for traumatic brain injury. In this group 2 patients had brain injury.

What does this mean? It means your child probably doesn't need a CT scan if they bump their head and are not vomiting, have no headache and are acting fine. This is often a hard one for parents to accept. The best treatment is often just observation.

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