Routine repeat brain computed tomography in all children with mild traumatic brain injury may result in unnecessary radiation exposure.
BACKGROUND
Computed tomography (CT) for pediatric traumatic brain injury (TBI) is common. Evidence suggests that 1 in 1,200 children undergoing CT will die of malignancy from radiation exposure. Presently, there is no protocol for surveying children with mild TBI; repeat CT (rCT) is often performed. We hypothesized that rCT could be avoided. Outcomes of similar patients who underwent rCT were compared with those of patients followed by clinical examination alone.


METHODS
An 8-year retrospective review was performed of patients admitted to a Level I pediatric trauma center with TBI, CT evidence of TBI, and Glasgow Coma Scale (GCS) score of 14 to 15. There were two groups, those who underwent rCT (rCT+) and those who did not (rCT-). Data included age, Injury Severity Score (ISS), mechanism of injury, type of TBI, and outcome. Patients with coagulopathies, ventriculoperitoneal shunts, developmental disabilities, nonaccidental trauma, concomitant injuries, or medical problems resulting in intubation or sedation not attributed to TBI were excluded.


RESULTS
Of 391 patients admitted with TBI, 120 were included in the study. A total of 106 patients were rCT+, and 14 were rCT-. rCT+ children were older (mean, 98.7 ± 7.3 vs. 35.3 ± 11.5 months; p = 0.0025) and more likely to have epidural hematoma (EDH) (100% rCT with EDH vs. 76% rCT all other TBI, p = 0.044). Mechanism of injury and mean ISS (15.2 ± 0.6 vs. 13.0 ± 1.1, p = 0.195) were not different between the groups. There were no worsening neurologic symptoms or need for surgery in rCT- children. rCT identified seven patients (6.6%) with CT progression of their injury. Five had an EDH, and two had a subarachnoid hemorrhage. Two children with EDH underwent operation.


CONCLUSIONS
Our study indicates that routine rCT without evidence of clinical deterioration is not indicated in children with admission GCS score of 14 to 15 and TBI on CT scan. Children with EDH seem to have a higher potential for progression, and rCT seems to be indicated in this subgroup.


METHODS
Therapeutic study, level IV.
From the Cardinal Glennon Children's Medical Center (J.H., D.R.L., A.G., D.W.V.), St. Louis, Missouri; and St. Louis CSTARS (C.M.F.), St. Louis University, St. Louis, Missouri.
Jarett
J
Howe
Colleen M
CM
Fitzpatrick
Dana Rachel
DR
Lakam
Ana
A
Gleisner
Dennis W
DW
Vane
D000293:Adolescent; D000367:Age Factors; D001930:Brain Injuries / Q000000981:diagnostic imaging* / Q000401:mortality* / Q000628:therapy; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D016208:Databases, Factual; D003955:Diagnostic Tests, Routine / Q000706:statistics & numerical data; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011829:Radiation Dosage; D011832:Radiation Injuries / Q000517:prevention & control; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed / Q000009:adverse effects* / Q000706:statistics & numerical data; D014193:Trauma Centers; D019564:Unnecessary Procedures