Choosing Wisely:

CT scans are not necessary in the evaluation of minor head injuries.

Rationale and Comments: Head injuries occur commonly in children and adolescents. Approximately 50% of children who visit hospital emergency departments with a head injury are given a CT scan, a considerable number of which are unnecessary. Unnecessary exposure to x-rays poses considerable danger to children, including increasing the lifetime risk of cancer because a child’s brain tissue is more sensitive to ionizing radiation. They also impose undue costs to the health care system. Clinical observation prior to CT decision making for children with minor head injuries is an effective approach.
Sponsoring Organizations:
  • American Academy of Pediatrics
  • Sources:
  • Systematic review and meta-analysis
  • Disciplines:
  • Neurologic
  • Pediatric
  • Emergency medicine
  • References: • Dunning J, et al. A meta-analysis of variables that predict significant intracranial injury in minor head trauma. Arch Dis Child. 2004;89(7):653-9.
    • Kuppermann N, et al. Identification of children at very low-risk of clinically-important brain injuries after head trauma: a prospective cohort study. 2009;374(9696):1160-70.
    • Nigrovic LE, et al. The effect of observation on cranial computed tomography utilization for children after blunt head trauma. Pediatrics. 2011;127(6):1067-73.
    • Oman JA, et al. Performance of a decision-rule to predict need for computed tomography among children with blunt head trauma. Pediatrics. 2006;117(2):e238-46.

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