Choosing Wisely:

Don’t routinely obtain CT scanning of children with mild head injuries.

Rationale and Comments: A mild traumatic brain injury is a temporary loss of neurologic function resulting from a blunt blow to the head or an acceleration/deceleration injury. There are predictors that a more severe injury has occurred and CT scanning may be appropriate. In patients younger than age two, a persistent altered mental status, non-frontal scalp hematoma, loss of consciousness for five seconds or more, severe injury mechanism, palpable skull fracture, or not acting normally according to the parent may be signs of a more serious injury. In patients older than two, prolonged abnormal mental status, any loss of consciousness, history of vomiting, severe injury mechanism, clinical signs of basilar skull fracture, or severe headache may also necessitate CT imaging. Any patient with a traumatic injury to the head that has any neurologic deficits should also be imaged if no other cause can be determined.
Sponsoring Organizations:
  • American Association of Neurological Surgeons and Congress of Neurological Surgeons
  • Sources:
  • Prospective cohort studies
  • Disciplines:
  • Pediatric
  • Neurologic
  • Emergency medicine
  • References: • Kuppermann N, et al. Identification of children at very low risk of clinically important brain injuries after head trauma: a prospective cohort study. Lancet. 2009 Oct 3;374(9696):1160–70.

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