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When are CT scans necessary for children in the emergency room?

More than one-fifth of children who receive CT scans following head trauma don't need them, researchers found in an article published this week in The Lancet.

Previous studies have suggested that CT scans were being overused for pediatric head trauma, but they were subject to various limitations, including small sample size and lack of validation or independent assessment in children younger than 2, according to the researchers.

Using 33,785 children, the researchers developed rules for classifying children as low risk. These children would not need CT scans.

Older children are considered low-risk if they have normal mental status, no loss of consciousness, no vomiting, no signs of basilar skull fracture, and no severe headache, and did not sustain their injury in a serious accident.

Because children younger than 2 are generally unable to communicate their symptoms, are more sensitive to the effects of radiation, and have different mechanisms of injury, the researchers said, they needed slightly different rules.

Those who had normal mental status, no scalp swelling except frontal, no loss of consciousness more than five seconds, and no palpable skull fracture, and were acting normally according to the parents and sustained their injury in a non-severe way were classified as low risk.

Interestingly, in an accompanying editorial, an important observation was made.  If these rules were followed, there would actually be more CT scans performed on children with head trauma than is being presently accomplished.

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