ACR Appropriateness Criteria Head Trauma—Child (original) (raw)
Related papers
Pediatric minor head trauma: do cranial CT scans change the therapeutic approach?
Clinics (Sao Paulo, Brazil), 2016
- To verify clinical signs correlated with appropriate cranial computed tomography scan indications and changes in the therapeutic approach in pediatric minor head trauma scenarios. 2) To estimate the radiation exposure of computed tomography scans with low dose protocols in the context of trauma and the additional associated risk. Investigators reviewed the medical records of all children with minor head trauma, which was defined as a Glasgow coma scale ≥13 at the time of admission to the emergency room, who underwent computed tomography scans during the years of 2013 and 2014. A change in the therapeutic approach was defined as a neurosurgical intervention performed within 30 days, hospitalization, >12 hours of observation, or neuro-specialist evaluation. Of the 1006 children evaluated, 101 showed some abnormality on head computed tomography scans, including 49 who were hospitalized, 16 who remained under observation and 36 who were dismissed. No patient underwent neurosurgery...
CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, 2018
There is uncertainty about which children with minor head injury need to undergo computed tomography (CT). We sought to prospectively validate the accuracy and potential for refinement of a previously derived decision rule, Canadian Assessment of Tomography for Childhood Head injury (CATCH), to guide CT use in children with minor head injury. This multicentre cohort study in 9 Canadian pediatric emergency departments prospectively enrolled children with blunt head trauma presenting with a Glasgow Coma Scale score of 13-15 and loss of consciousness, amnesia, disorientation, persistent vomiting or irritability. Phys icians completed standardized assessment forms before CT, including clinical predictors of the rule. The primary outcome was neurosurgical intervention and the secondary outcome was brain injury on CT. We calculated test characteristics of the rule and used recursive partitioning to further refine the rule. Of 4060 enrolled patients, 23 (0.6%) underwent neurosurgical inter...
Effective Correlation of Imaging Features with Head Injury-CME-Taylor's Journal Club.docx
Effective Correlation of Imaging Features with Head Injury -Associate Prof Dr. Abdul Kareem Meera Mohaideen DOI: 10.13140/RG.2.2.11691.44325 Traumatic brain injury (TBI) is a leading cause of mortality and morbidity in the world’s population, especially those under age 44. Head trauma has a high emotional, psychosocial and economic impact globally because these patients often have comparatively long hospital stays and physically limiting post-traumatic sequences. Trauma is also a leading cause of death in children older than 1 year, with head trauma representing 80% or more of the injuries. Plain radiography of skull are poor predictors of intracranial pathology as it rarely demonstrates significant findings. In the high-risk patients, the lack of abnormality on skull films does not exclude major intracranial injury. Those patients must be imaged by Computed tomography (CT). The “scout view” that is obtained with all CT exams can be used as a “pseudoskull film. The radiological evaluation of head injuries has been dramatically altered by the advent of CT and MR imaging. CT of the head remains the main and the most useful imaging modality in acute setting for patients with severe head trauma or unstable multiple organ injury. All the traumatic brain injury (TBI) cases may be classified as mild, moderate and severe basing on the clinical and imaging findings. Imaging findings such as subgaleal hematoma, skull fractures, subarachnoid hemorrhage, cerebral contusion, intracerebral hemorrhage, extra-axial blood collection and diffuse cerebral edema were observed in 70-80% of the patients. MR imaging is a versatile modality that has been applied in almost all kinds of injuries in the brain, spinal cord and the surrounding structures. MRI is useful for estimating the initial mechanism and extent of injury and predicting its outcome in the neurologically stable patient. MRI has been shown to be superior to CT in the detection of non-hemorrhagic brain injury and cases of diffuse axonal injury. However, there are some limitations, such as low detectability of subarachnoid hemorrhage, difficulty in visualization of bony details, and various kinds of artifacts. It is not practical in emergency situations, because the magnetic field limits the use of the monitors and life-support equipment needed by unstable patients. MRI is typically reserved for patients who have mental status abnormalities unexplained by CT scan findings. On the other hand, there have also been considerable technical advances in other imaging modalities, such as spiral CT, Doppler US, etc. With the continuous advance in each imaging modality, their roles and the strategy in the diagnosis of disorders of central nervous system in head injuries will be changed. Statistical significance was observed between GCS and the imaging findings, the lower the GCS score, the more severe were the TBI and imaging findings. Patients with multiple organ injuries, including head trauma, generally have a far worse outcome than those with head injury alone. Long-term complications of head injury are common in children, and they are related to both primary and secondary injuries. The radiological evaluation of central nervous system has been dramatically altered by the advent of MR imaging. MR imaging is a versatile modality that has been applied in almost all kinds of disorders in the brain, spinal cord and the surrounding structures. However, there are some limitations, such as low detectability of subarachnoid hemorrhage or calcifications, difficulty in visualization of bony details, and various kinds of artifacts. On the other hand, there have also been considerable technical advances in other imaging modalities, such as spiral CT, doppler US, etc. With the continuous advance in each imaging modality, their roles and the strategy in the diagnosis of disorders in central nervous system will be changed. Molecular imaging is an attractive technology widely used in clinical practice that greatly enhances our understanding of the pathophysiology and treatment.
Managing traumatic brain injury in children: When do we need a computed tomography of the head?
Sudanese journal of paediatrics, 2014
Accidents still represent a major cause of death and disability in children. The resultant traumatic brain injury (TBI) usually needs a multidisciplinary approach of management. Although computed tomographic (CT) head scan is generally a preferred investigation in TBI, however, clear guidelines are required to help decision making by different team members on "when a head CT scan is needed", its limitations, and "when it is likely to be informative". The answers to these queries are highlighted, in the present article, with other aspects of treatment of children with TBI. This article discusses different worldwide-accepted approaches for managing children with TBI, and places special emphasis on the issue of "indications for a head CT scan".
Indications for head computed tomography in children with mild traumatic brain injury
Revista do Colégio Brasileiro de Cirurgiões
The "Evidence Based Telemedicine - Trauma and Emergency Surgery" (TBE-CITE) performed a critical appraisal of the literature and selected the three most relevant and recent publications on the indications for head computed tomography (CT) scan in pediatric patients with mild traumatic brain injury (TBI). The first study identified patients with mild TBI, high and low risk factors for intracranial injuries detected on CT scan and need for neurosurgical intervention. The second study evaluated the guidelines of the National Institute of Clinical Excellence for pediatric patients with TBI. The outcome of this study was either performing a head CT scan or hospital admission. The last study identified and analyzed the patients in whom the CT scan is not necessary and consequently should not be routinely indicated. Based on the critical appraisal of the literature and expert discussion, the opinion of the TBE-CITE was to favor the adoption of the PECARN guidelines, proposing CT ...