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Children Kept Under Observation in ER Diminishes Need for CT Scans

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Based on the results of a study published online Friday in Annals of Emergency Medicine "Impact of the Duration of Emergency Department Observation on Computed Tomography Use in Children with Minor Blunt Head Trauma", the longer a child with mild head trauma, is kept under observation in the emergency department (ER), the chances of the child requiring a computed tomography (CT) scan is greatly reduced.children head trauma

"Every hour of observation time in the emergency department was associated with a decrease in CT rates for children whether at low, intermediate or high risk of traumatic brain injury. Furthermore, observation prior to CT decision-making for children with minor blunt head trauma was associated with reduced CT use without an observed delay in the diagnosis of significant traumatic brain injury," said lead study author of the study and medical personnel of Boston Children's Hospital in Boston, Mass,  Lise E. Nigrovic, MD, MPH. 

1,381 children with mild head trauma were kept under observation prior to deciding whether to obtain CT scans or not. Of the 1,381 emergency physicians observed around half (49 percent) of them. Throughout the period(s) of observation most of the children’s symptoms began to improve. For every hour of observation CT requirement was significantly reduced approximately 70 percent of the time. 

Almost every year, more than half a million children are received by the emergency department for evaluation of mild head trauma, yet very few will have significant traumatic brain injury.

"As emergency physicians, we must balance the possibility of missing a clinically significant traumatic brain injury with the future risk of malignancy associated with ionizing radiation exposure. Observation prior to CT decision-making has the potential to further reduce CT rates without missing children with significant injuries, further improving the emergency care of children with minor blunt head injury,” said Nigrovic.

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