To CT or Not to CT: Risks of Missed Brain Injury vs. Radiation Exposure in Young Children

 For children <2 years of age, the benefit of computed tomography outweighs the risk of malignancy only for those at highest risk for brain injury.

Computed tomography (CT) imaging decisions for children <2 years of age with minor blunt head trauma must balance the risk of radiation-associated malignancies against the risk of missed clinically important traumatic brain injuries (ciTBI, defined as head injury resulting in death or requiring neurosurgery, endotracheal intubation for >24 hours, or hospital admission for 2 nights). Using data from the Pediatric Emergency Care Applied Research Network (PECARN) cohort of children <2 years of age with blunt head trauma and Glasgow Coma Scale (GCS) scores of 14 or 15, researchers performed decision analyses to evaluate two strategies: imaging all patients or imaging no patients. Analyses were performed for the entire cohort and for a subgroup at high risk for ciTBI (GCS score of 14, other signs of altered mental status, or palpable skull fracture).

For all 10,718 patients, with an expected probability of ciTBI of 0.9%, the optimal strategy to minimize overall radiation risk was no CT, and a ciTBI risk of 4.8% was the threshold above which the optimal strategy would change to imaging all patients. For the 1490 patients at high risk for ciTBI, with an expected probability of 4.4%, the optimal strategy was imaging all patients, and a ciTBI risk of 3.6% was the threshold below which the optimal strategy would change to no imaging.

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