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New Tool Can Determine Need for CT Scans in Children With Minor Head Injury OTTAWA, Ontario -- February 8, 2010 -- A new tool may help standardise the use of computed tomography (CT) scans in children with minor head injury and help reduce the number of scans, according to a study published in the Canadian Medical Association Journal. Martin H. Osmond, MD, Department of Pediatrics, University of Ottawa, Ottawa, Ontario, and colleagues have developed the Canadian Assessment of Tomography for Childhood Injury (CATCH) to guide physicians in determining whether a child with minor head trauma should receive a CT scan. There is considerable debate when it comes to the use of CT scans. Some support routine CT scanning of all minor head injury patients, while others are more selective. “We believe an accurate clinical decision rule, like the CATCH Rule, can stabilise or reduce the number of children receiving a CT scan, thereby minimising both healthcare costs and exposure to the potentially harmful effects of ionising radiation,” the authors wrote. “There is growing concern that early exposure to ionising radiation may result in a significant rise in lifetime fatal cancer risk.” The study involved 3,866 children aged 0 to 16 years from 10 Canadian paediatric teaching institutions. Of the patients, 95 (2.5%) had a score of 13 on the Glasgow Coma Scale, 282 (7.3%) had a score of 14, and 3489 (90.2%) had a score of 15. CT revealed that 159 (4.1%) had a brain injury, and 24 (0.6%) underwent neurologic intervention. The decision to rule out CT of the head consisted of 4 high-risk factors (failure to reach score of 15 on the Glasgow coma scale within 2 hours, suspicion of open skull fracture, worsening headache, and irritability) plus 3 medium-risk factors (large, boggy haematoma of the scalp, signs of basal skull fracture, and dangerous mechanism of injury). The high-risk factors were 100.0% sensitive for predicting the need for neurologic intervention and would require that 30.2% of patients undergo CT. The medium-risk factors resulted in 98.1% sensitivity for the prediction of brain injury by CT and would require that 52.0% of patients undergo CT. The authors noted that further studies are required to validate this rule in other paediatric age groups. SOURCE: Canadian Medical Association Journal E-mail this page to a friend or colleague! To print, use this version