Clinical predictors of abnormal computed tomography scans in paediatric head injury.
OBJECTIVE
To evaluate whether clinical features associated with head injury in children can be correlated with an abnormal computed tomography (CT) scan.


METHODS
Three hundred and eleven children aged 14 years or younger admitted with a diagnosis of acute head injury were studied retrospectively.


RESULTS
A Glasgow Coma Scale (GCS) score of 12 or lower and the presence of focal neurological deficits were significant predictors of an abnormal CT scan. Ninety-five per cent of those with abnormal CT scans and 100% of those with intracranial injury could be identified by the presence of one or more of the nine clinical findings, particularly by a GCS score of 12 or lower, and the presence of focal neurological deficits. Identification was also possible to a lesser degree by loss of consciousness, ataxia, amnesia, drowsiness, headache, seizure or vomiting.


CONCLUSIONS
Use of CT scans can be limited to children with ongoing specific symptoms and/or focal neurological signs. The implementation of guidelines in the management of head injuries in children could have a substantial effect on clinical practice and health-care costs.
Ng
S M
SM
Department of Paediatrics, Royal Hobart Hospital, Hobart, Tasmania, Australia. ngszemay@yahoo.com
Toh
E M
EM
Sherrington
C A
CA
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D006259:Craniocerebral Trauma / Q000175:diagnosis* / Q000000981:diagnostic imaging* / Q000209:etiology; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009460:Neurologic Examination; D018579:Patient Selection; D010808:Physical Examination; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D013648:Tasmania; D014057:Tomography, X-Ray Computed