Decision aid programs can inform parents about CT scans for children with head injuries

Each year in the United States, an estimated 450,000 children visit emergency departments to receive an evaluation for minor head trauma. In about half of cases, clinicians use cranial computed tomography (CT) scanning, a common brain imaging technique, to determine the extent of a child’s head injuries. However, fewer than 10% of these scans show evidence of traumatic brain injury (TBI). Clinicians want to reduce the frequency of unnecessary CT scans by refining prediction guidelines for children with head trauma, which will allow clinicians and caregivers to make more informed choices about children’s health care needs.

Recently, the Pediatric Emergency Care Applied Research Network (PECARN) developed a set of prediction tools for determining TBI risk factors in young children. A CT scan is only recommended if a child exhibits two or more risk factors for TBI, reducing the number of children who unnecessarily undergo CT scanning for potential head injuries. Unfortunately, the PECARN prediction rules don’t provide much decision-making support for evaluating children who score at “moderate risk” for TBI, leaving a knowledge gap for patients who prefer an active role in decision-making processes.

To address this gap, a group of researchers designed a decision-making aid process to best inform parents about care options and CT scan procedures for their children. Clinicians and parents had one-on-one conversations about decision-making options and health care management for children with TBI. For example, clinicians explained potential issues related to CT scans (including cost and sedation) and provided information about TBI symptoms in children. After assessing parents’ knowledge of CT decision-making processes, the researchers found that:

  • Parents who received decision aid training had greater knowledge of the CT scan process.
  • Those who were guided through the decision-making process felt less conflicted about their health care choices.
  • Every child with clinically important TBI received an appropriate diagnosis; no injuries were missed.

Although CT scanning is a valuable tool for evaluating head trauma, more than 90% of children who receive CT scans for minor head injuries don’t have significant TBI. When parents receive support and guidance from clinicians, they feel more confident in their decisions regarding the necessity of CT scans for their children. Crucially, these decision-making partnerships have the potential to decrease the number of unnecessary CT scans administered to children with head injuries.

Hess EP, Homme JL, Kharbanda AB, et al. Effect of the head computed tomography choice decision aid in parents of children with minor head trauma. Jama Network Open. (September 2018).


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