CT or No-CT? How To Decide If Your Child Needs a CT After Concussion

Child in Hospital Bed

Children who are under age 2 are at increased risk of head injury. It is difficult to assess the severity of injury in very young children, and although it is rare, dangerous complications can occur. One way to assess this risk is to administer a CT scan. However, the CT scan itself carries a risk of exposure to radiation. At the emergency department, parents and clinicians are often in a dilemma-to use a CT scan to rule out injuries that may worsen and need immediate treatment, or to not use a CT scan in order to limit exposure to radiation?

A recent study has suggested some guidelines to help the decision process. For children who are younger than 2, and who have a Glasgow Coma Scale (GCS) of 14-15, the optimal strategy is to not use CT immediately after injury. Instead, the researchers suggest using a period of observation for the few days after the injury. This not only reduces the risk of exposure to radiation, but it is significantly cost-effective for both the hospital and the family.

Hennelly KE, Mannix R, Nigrovic LE, et al. Pediatric traumatic brain injury and radiation risks: A clinical decision analysis. The Journal of Pediatrics. (September 2012).