Children Kept Under Observation in the ER Lessens Need for CT Scanning

The longer a child with minor blunt head trauma is seen in the emergency department (ED), the less apt the child is to require computed tomography (CT) imaging, according to new research.

The study’s findings were published online August 9, 2013, in the journal Annals of Emergency Medicine. “Every hour of observation time in the emergency department was associated with a decrease in CT rates for children whether at low, intermediate or high risk of traumatic brain injury,” said lead study author Lise E. Nigrovic, MD, MPH, of Boston Children’s Hospital (MA, USA). “Furthermore, observation prior to CT decision-making for children with minor blunt head trauma was associated with reduced CT use without an observed delay in the diagnosis of significant traumatic brain injury.”

Emergency physicians observed approximately half (49%) of the 1,381 enrolled children with minor blunt head trauma prior to deciding whether to obtain CT scans. The symptoms improved for most children during the observation period. Every hour of observation reduced CTs by approximately 70% on average.

Annually, more than half a million children in the United States alone come to the ED for assessment of blunt head trauma, but very few will have considerable traumatic brain injury. “As emergency physicians, we must balance the possibility of missing a clinically significant traumatic brain injury with the future risk of malignancy associated with ionizing radiation exposure,” concluded Dr. Nigrovic. “Observation prior to CT decision-making has the potential to further reduce CT rates without missing children with significant injuries, further improving the emergency care of children with minor blunt head injury.”

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