title: ACR Appropriateness Criteria head trauma--child.
abstract: Head trauma is a frequent indication for cranial imaging in children. CT is considered the first line of study for suspected intracranial injury because of its wide availability and rapid detection of acute hemorrhage. However, the majority of childhood head injuries occur without neurologic complications, and particular consideration should be given to the greater risks of ionizing radiation in young patients in the decision to use CT for those with mild head trauma. MRI can detect traumatic complications without radiation, but often requires sedation in children, owing to the examination length and motion sensitivity, which limits rapid assessment and exposes the patient to potential anesthesia risks. MRI may be helpful in patients with suspected nonaccidental trauma, with which axonal shear injury and ischemia are more common and documentation is critical, as well as in those whose clinical status is discordant with CT findings. Advanced techniques, such as diffusion tensor imaging, may identify changes occult by standard imaging, but data are currently insufficient to support routine clinical use. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 3 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.
authors.affiliation: Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois. Electronic address: mryan@luriechildrens.org.
authors.forename: Maura E
authors.initials: ME
authors.lastname: Ryan
authors.affiliation: Children's Hospital of Atlanta, Atlanta, Georgia.
authors.forename: Susan
authors.initials: S
authors.lastname: Palasis
authors.affiliation: University of Miami Health System, Miami, Florida.
authors.forename: Gaurav
authors.initials: G
authors.lastname: Saigal
authors.affiliation: University of Miami Jackson Memorial Hospital, Miami, Florida.
authors.forename: Adam D
authors.initials: AD
authors.lastname: Singer
authors.affiliation: Riley Hospital for Children, Indiana University, Indianapolis, Indiana.
authors.forename: Boaz
authors.initials: B
authors.lastname: Karmazyn
authors.affiliation: Texas Scottish Rite Hospital, Dallas, Texas.
authors.forename: Molly E
authors.initials: ME
authors.lastname: Dempsey
authors.affiliation: C. S. Mott Children's Hospital, Ann Arbor, Michigan.
authors.forename: Jonathan R
authors.initials: JR
authors.lastname: Dillman
authors.affiliation: Children's Hospitals, San Diego, California.
authors.forename: Christopher E
authors.initials: CE
authors.lastname: Dory
authors.affiliation: Division of General and Hospital Pediatrics, Columbia, South Carolina; American Academy of Pediatrics, Elk Grove Village, Illinois.
authors.forename: Matthew
authors.initials: M
authors.lastname: Garber
authors.affiliation: Children's Healthcare of Atlanta, Atlanta, Georgia.
authors.forename: Laura L
authors.initials: LL
authors.lastname: Hayes
authors.affiliation: Seattle Children's Hospital, Seattle, Washington.
authors.forename: Ramesh S
authors.initials: RS
authors.lastname: Iyer
authors.affiliation: New Jersey Pediatric Neuroscience Institute, Morristown, New Jersey; American Association of Neurological Surgeons, Rolling Meadows, Illinois/Congress of Neurological Surgeons, Schaumburg, Illinois.
authors.forename: Catherine A
authors.initials: CA
authors.lastname: Mazzola
authors.affiliation: St. Paul Radiology PA, St. Paul, Minnesota.
authors.forename: Molly E
authors.initials: ME
authors.lastname: Raske
authors.affiliation: Duke University Medical Center, Durham, North Carolina; American Pediatric Surgical Association, Deerfield, Illinois.
authors.forename: Henry E
authors.initials: HE
authors.lastname: Rice
authors.affiliation: Children's Memorial Hospital, Chicago, Illinois.
authors.forename: Cynthia K
authors.initials: CK
authors.lastname: Rigsby
authors.affiliation: Christiana Care Health System, Newark, Delaware; American College of Emergency Physicians, Irving, Texas.
authors.forename: Paul R
authors.initials: PR
authors.lastname: Sierzenski
authors.affiliation: C. S. Mott Children's Hospital, Ann Arbor, Michigan.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Strouse
authors.affiliation: Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Sjirk J
authors.initials: SJ
authors.lastname: Westra
authors.affiliation: University of California Davis, Sacramento, California.
authors.forename: Sandra L
authors.initials: SL
authors.lastname: Wootton-Gorges
authors.affiliation: Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
authors.forename: Brian D
authors.initials: BD
authors.lastname: Coley
mesh_terms: D002648:Child; D002675:Child, Preschool; D006259:Craniocerebral Trauma / Q000150:complications / Q000175:diagnosis*; D003952:Diagnostic Imaging / Q000592:standards*; D019317:Evidence-Based Medicine; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D011871:Radiology / Q000592:standards*; D012307:Risk Factors; D014481:United States
keywords: Appropriateness criteria; CT; MRI; head trauma; nonaccidental injury; pediatric