CT Not Needed for Minor Head Injuries in Children According to UC Davis, Boston Children’s Hospital study

Children who have only isolated loss of consciousness after head trauma do not routinely require CT head scans, according to research from the UC Davis Health System and Boston Children’s Hospital published in JAMA Pediatrics. The researchers evaluated data from more than 40,000 children evaluated in hospital emergency departments (EDs) for head trauma. They found that if children only had loss of consciousness and no other signs or symptoms related to the head trauma, they are very unlikely to have sustained serious brain injuries.

“Fear of missing a clinically significant head injury and the wide availability of CT scanners, have been the main factors driving an increase in the use of CT imaging over the past two decades,” says Nathan Kuppermann, MD, MPH, chair of the UC Davis department of emergency medicine, and principal investigator of the study. “Our findings can help doctors confidently make a decision to forego CT testing when their patients are unlikely to benefit from it, enabling physicians to first observe their patients for a period of time before deciding on CT use.”

The current study found that children who lost consciousness after head trauma, but were awake and alert in the ED, and showed none of the other five factors identified in the Pediatric Emergency Care Applied Research Network (PECARN) traumatic brain injury prediction rules had a 0.5% rate of clinically important brain injuries.

If a child had isolated loss of consciousness without any other signs or symptoms of head trauma (ie, including factors outside of the PECARN traumatic brain injury prediction rules), the incidence of an important brain injury dropped to only 0.2%, or 1 in 500 children. Furthermore, the duration of the loss of consciousness did not significantly affect risk.

“Children with clinically important brain injuries rarely have loss of consciousness alone and almost always present other symptoms, such as vomiting or showing signs of neurological problems,” says Lois K. Lee, MD, MPH, lead study author and director of trauma research at Boston Children’s Hospital. “Being able to make treatment decisions backed by strong data helps doctors and parents feel better about deciding whether further testing is really needed.” 

Lee adds that in cases in which a parent or physician is uneasy about a child’s condition, it would be reasonable to observe the child in the ED for a few hours to see if any other signs or symptoms arise before making the decision whether to have a CT scan.