Head CT needed? (Pediatric MHT)
Info
Age<21 years Yes No
Glasgow Coma Scale>12 Yes No
History of LOC Yes No
Posttraumatic amnesia Yes No
Dizziness Yes No
Palpable skull defect Yes No
Sensory deficit Yes No
Mental status change Yes No
Bicycle related injury Yes No
Age <2 years Yes No
GCS<15 Yes No
Evidence of basilar skull fracture Yes No
R e s u l t s
---
 
Score
 
Show Results
Info
Head CT needed? (Pediatric MHT)

This 2008 study examined 1000 patients presenting with minor head trauma to four level I pediatric trauma centers (younger than 21 years with mean age 8.9 years). 6.5% had positive findings on CT, with 6 of these 65 positive findings requiring neurosurgical intervention.

Head CT is negative in 83-97% of minor head trauma (MHT) cases; and providing a head CT to all cases is both expensive and exposes children to radiation, possibly unnecessarily.

The goal was to develop a sensitive clinical decision rule that had a high negative predictive value; and thus could enter into the physician's clinical assessment.

Definition of minor head trauma (MHT)

  • Glasgow Coma Scale >12

PLUS 1 or both of the following:

  • History of loss of consciousness (LOC)
  • Posttraumatic amnesia

The presence of any of the following items led to CT Head being recommended:

  • Dizziness
  • Skull defect
  • Sensory deficit
  • Mental status change
  • Bicycle related injury
  • Age <2 years
  • GCS <15
  • Evidence of basilar skull fracture (Battle sign, rhinorrhea, hemotympanum, Periorbital ecchymosis, or otorrhea with CSF).

The absence of any of these 8 factors gave a 99.3% negative predictive value; and could favor observation of these patients instead of head CT. In this study, 3 of the 65 patients who had intracranial injury were not identified by this rule; however, none of these 3 patients required neurosurgical intervention.

The authors also advise, that the presence of any of these 8 items does not imply that head CT needs to be performed; but instead, that this data does not support exclusion of intracranial injury in such patients.

Reference:
Atabaki SM, Stiell IG, Bazarian JJ, et al. A clinical decision rule for cranial computed tomography in minor pediatric head trauma. Arch Pediatr Adolesc Med. 2008;162(5):439-45.