Original ArticlePediatric Traumatic Brain Injury and Radiation Risks: A Clinical Decision Analysis
Section snippets
Methods
This study based on literature review was exempt from review by our Institutional Review Board. The authors constructed a decision analysis model for children younger than 2 years with blunt head trauma and a GCS score of 14-15 for 2 strategies: (1) CT all; or (2) no CT (ie, no immediate CT for any children, which is depicted in Figure 1 as square decision nodes). As shown in the decision tree, following the decision of obtaining a CT or not obtaining a CT, physicians will observe the outcome
Results
We find relatively high overall utilities due to the preponderance of children in the baseline health state (with or without CT), which for our study population is mostly perfect health. Overall, the no-CT strategy yields an expected utility of 0.991 and the CT-all strategy yields a utility of 0.985, which suggests that at the expected or prior probability of ciTBI for this population of 9:1000 [ie, p(ciTBI) = 0.9%], no CT represents the optimal strategy. Figure 2, A shows the sensitivity
Discussion
Our decision analysis model suggests that for children younger than 2 years with blunt head trauma presenting to the ED with GCS scores of 14-15, the no-CT strategy appears optimal based on an expected prior probability of ciTBI of 0.9% when considering health-related quality of life outcomes and the risk of radiation over time. This result occurs because cranial CT increases the lifetime risk of lethal malignancy for a child (based on a CT radiation dose of 2 mSv) and reveals a ciTBI in a
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2018, Journal of PediatricsComparison of PECARN, CATCH, and CHALICE rules for children with minor head injury: A prospective cohort study
2014, Annals of Emergency MedicineCitation Excerpt :Clinically important intracranial injuries are rare, occurring in less than 5% of children presenting to the emergency department (ED) with minor head injury (Glasgow Coma Scale [GCS] scores of 13 to 15), and injuries requiring neurosurgical intervention occur in less than 1% of children.3 Decision analyses suggest that for most children who are at low risk of traumatic brain injury, the risks of radiation outweigh the risks of traumatic brain injury, and CT is not warranted.4 Despite this, more than one third of children with minor head injury undergo CT.5
Pediatric head injury and concussion
2013, Emergency Medicine Clinics of North AmericaCitation Excerpt :The lifetime risk of fatal cancer from a single head CT has been estimated to be 1 in 1500 for a 1-year-old and 1 in 5000 for a 10-year-old.8 Other reports have also shown increased risks of both brain tumors and leukemia associated with CT scans in childhood and encourage physicians to weigh the risks and benefits before ordering these studies.9–12 In addition, children often require procedural sedation to obtain a CT scan because of fear, agitation, or young age and procedural sedation carries the risk of airway and hemodynamic compromise.
The authors declare no conflicts of interest.