Study Says Observation First Could Cut CT Scans in Children with Head Injuries

A new study published in the journal Pediatrics says children are being subjected to <"">unnecessary CT scans following head injuries. The authors of the study, researchers at Boston and UC Davis, call for more children to be placed under observation first in order to avoid unnecessary CT scans.

As we’ve reported in the past, excessive exposure to medical radiation can significantly increase the risk of cancer. According to a report from the Los Angeles Times, a 2009 study found that the increasing use of CT scans could cause thousands of additional cancers and 14,500 more deaths each year. A just-published study by the Cincinnati Children’s Hospital that reviewed trends across the U.S. revealed a massive five-fold increase in pediatric CT scan use in children that jumped from 330,000 (1995) to 1.65 million (2008).

Because their cells are still rapidly dividing, children are more vulnerable to the effects of medical radiation compared to adults. Yet a 2007 study in the New England Journal of Medicine (NEJM) found that most doctors underestimate the radiation risk posed by CT scans. The same study authors believed there may be over 1 million unnecessary CT scans performed on American children annually.

For the Pediatrics study, the authors gathered data from PECARN (the Pediatric Emergency Care Applied Research Network) and looked at outcomes from 40,000 pediatric head injury cases in 25 emergency departments. Of those, 14 percent underwent observation before doctors made a decision on performing a CT scan. Thirty-one percent of those who underwent observation first were not subjected to a CT scan, compared to 35 percent who were not observed. The difference between the two groups widened when the head injuries were more severe. Children placed under observation first had half the likelihood of having to undergo a CT scan.

Doctors who chose observation first didn’t miss injuries any more often than did the doctors who went straight to a CT scan.

The researchers concluded that for every 1,000 children being assessed for traumatic brain injury, a period of observation could result in 39 fewer CT scans.

The study authors had the following advice for parents:

• Check with your primary care physician before heading to the ER for treatment.

• Children who complain of a headache, vomiting or confusion in conjunction with a head injury need to go to the ER, especially if symptoms worsen over time.

• It’s reasonable for an emergency room physician to choose monitoring for several hours instead of an immediate CT scan.

• If your child is released from the hospital without a CT scan and symptoms get worse over time, head back to the ER.

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