Hospitalizing children with normal CTs after head trauma may be unnecessary

A national multicenter study of thousands of children taken into emergency departments with minor blunt head trauma has found that most of those with normal CT scans do not require hospitalization for further observation.

The study, published online in the Annals of Emergency Medicine, was conducted under the auspices of the Pediatric Emergency Care Applied Research Network (PECARN), according to a University of California – Davis Health System press release. Of the more than 13,500 children included in the study, less than 1% had subsequent abnormal CT scans or MRIs — and none required neurosurgical intervention.

“We now have definitive evidence supporting discharging most neurologically normal children with head trauma after negative CT scans home from the emergency department,” lead author James Holmes, MD, MPH, stated in the release. “Sending these patients home with their parents not only provides good, safe care, but it also saves costs. It is a win for everyone concerned.”

The team performed a prospective, observational cohort study of children younger than 18 years with blunt head trauma who reported to 25 centers from June 2004 to September 2006. Overall, 13,543 children were enrolled. Children with isolated head trauma — as well as those with other injuries — were included in the study.

According to the release, the team obtained initial CT results for each patient, with “normal” results consisting of radiological scans that did not reveal intracranial hemorrhage, cerebral concussion, cerebral edema or skull fractures. Follow-up telephone calls were placed to 11, 058 discharged patients at least one week after the emergency department visit, and data collected with regards to any additional CT scans, MRI scans or neurosurgical interventions the patients may have received. Nearly 2, 5000 patients were followed during their hospitalization.

Successful follow-up was completed for 8,756 of the discharged patients, with 197 receiving subsequent CT or MRI. Five reported abnormal CT/MRI results, and none reported receiving neurosurgical intervention. In the 2,485-patient hospitalization group, 137 were reported as having received subsequent CT or MRI. Sixteen of these reported abnormal CT/MRI scan results and none required surgery.

Though hundreds of patients underwent repeated CT or MRI scans, the authors noted, none required neurosurgical intervention — indicating there is a “very low risk” for patients to deteriorate after an initially normal cranial CT scan.

“Hospitalization of children with minor head trauma after normal CT scan results for neurologic observation is generally unnecessary,” they wrote.

References:

Holmes JF, Borgialli DA, Nadel FM, et al. Do children with blunt head trauma and normal cranial computed tomography scan results require hospitalization for neurologic observation? Ann Emerg Med. Published online June 17, 2011. doi:10.1016/j.annemergmed.2011.03.060

Disclosure: The study and PECARN are funded by the U.S. Department of Health and Human Services' Health Resources and Services Administration/Maternal and Child Health Bureau, Division of Research, Training, and Education, and the agency's Emergency Medical Services for Children.

www.ucdmc.ucdavis.edu

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