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  Study: New prediction rules will help emergency department doctors decide when CT scans are necessary for children with head injuries
May 30, 2010

Criteria driven by large-scale study shown to reduce unnecessary CT scans for children

Washington, DC – Doctors at Children’s National Medical Center have demonstrated that following a prediction rule for children with head injuries will likely improve how emergency department doctors decide when a child with head trauma does not require a CT scan. Applying better criteria to pinpoint the small percentage of children who truly need the CT scan may reduce unnecessary tests and lower the number of children exposed to a CT scan’s radiation levels for no reason, the study authors write.

The prediction rules are a set of clinical criteria designed from the largest prospective study of pediatric head injuries ever completed, and its effectiveness in practice was the focus of an abstract from Children’s National presented at the Pediatric Academic Societies Annual Meeting as well as the Society for Academic Emergency Medicine.

Lead author Shireen Atabaki, MD, and study principal investigator Nathan Kuppermann, MD, showed that compared to emergency department doctors’ clinical judgment of risk of important head injuries, application of the prediction rules was significantly more successful at predicting which children truly required a CT for further diagnosis and which children did not. Prior to the publication of these data-driven, measurable criteria via a Pediatric Emergency Care Applied Research Network (PECARN) study published last October in The Lancet, no large scale research-based prediction rule existed to help doctors rule out the need for a CT for children. Doctors relied on their training and clinical intuition to decide when to prescribe a CT, and the study confirmed that the rate of non-essential CT scans for children remains high.

“Doctors in the emergency department often take a ‘better safe than sorry’ approach when it comes to ordering CT scans for children with mild head trauma,” said Dr. Atabaki, a pediatric emergency physician at Children’s National. “This study shows us that data-driven criteria actually can help doctors in the field to avoid a CT on children that do not meet high risk criteria, and therefore avoid unnecessary exposure to the radiation that accompanies the scan, without the risk of missing important brain injuries.”

The study that initially developed the criteria was a multi-institutional collaboration as part of PECARN, led by a team at UC Davis. Based on a sample of more than 42,000 children with head trauma from 25 hospitals in the PECARN database, two separate sets of rules were developed, one for children under the age of 2, and one for children over the age of 2, outlining symptoms and conditions that identify children at higher risk of further complications from a head injury. The decision-making criteria include:

  • The way the child was injured
  • The child’s mental status at the time of evaluation
  • A history of loss of consciousness
  • Evidence of skull fracture
Although these criteria in no way replace clinical judgment, they can help physicians supplement their clinical judgment and instincts, when evaluating children with head trauma, with a set of evidence-based criteria for the first time.

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Contact: Emily Dammeyer/Jennifer Leischer: 202-476-4500

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Children’s National Medical Center, located in Washington, DC, is a leader in the development of innovative new treatments for childhood illness and injury. Children’s has been serving the nation’s children for more than 135 years. Children’s National is consistently ranked among the best pediatric hospitals by U.S.News & World Report and the Leapfrog Group. For more information, visit www.ChildrensNational.org. Children’s Research Institute, the academic arm of Children’s National Medical Center, encompasses the translational, clinical, and community research efforts of the institution. Learn more about Children’s Research Institute at www.ChildrensNational.org/Research.