Skip to main content
Advertisement

Main menu

  • Home
  • Content
    • Current Issue
    • Accepted Manuscripts
    • Article Preview
    • Past Issue Archive
    • Video Articles
    • AJNR Case Collection
    • Case of the Week Archive
    • Case of the Month Archive
    • Classic Case Archive
  • Special Collections
    • Low-Field MRI
    • Alzheimer Disease
    • ASNR Foundation Special Collection
    • Photon-Counting CT
    • AJNR Awards
    • View All
  • Multimedia
    • AJNR Podcasts
    • AJNR SCANtastic
    • Trainee Corner
    • MRI Safety Corner
    • Imaging Protocols
  • For Authors
    • Submit a Manuscript
    • Submit a Video Article
    • Submit an eLetter to the Editor/Response
    • Manuscript Submission Guidelines
    • Statistical Tips
    • Fast Publishing of Accepted Manuscripts
    • Graphical Abstract Preparation
    • Imaging Protocol Submission
    • Author Policies
  • About Us
    • About AJNR
    • Editorial Board
    • Editorial Board Alumni
  • More
    • Become a Reviewer/Academy of Reviewers
    • Subscribers
    • Permissions
    • Alerts
    • Feedback
    • Advertisers
    • ASNR Home

User menu

  • Alerts
  • Log in

Search

  • Advanced search
American Journal of Neuroradiology
American Journal of Neuroradiology

American Journal of Neuroradiology

ASHNR American Society of Functional Neuroradiology ASHNR American Society of Pediatric Neuroradiology ASSR
  • Alerts
  • Log in

Advanced Search

  • Home
  • Content
    • Current Issue
    • Accepted Manuscripts
    • Article Preview
    • Past Issue Archive
    • Video Articles
    • AJNR Case Collection
    • Case of the Week Archive
    • Case of the Month Archive
    • Classic Case Archive
  • Special Collections
    • Low-Field MRI
    • Alzheimer Disease
    • ASNR Foundation Special Collection
    • Photon-Counting CT
    • AJNR Awards
    • View All
  • Multimedia
    • AJNR Podcasts
    • AJNR SCANtastic
    • Trainee Corner
    • MRI Safety Corner
    • Imaging Protocols
  • For Authors
    • Submit a Manuscript
    • Submit a Video Article
    • Submit an eLetter to the Editor/Response
    • Manuscript Submission Guidelines
    • Statistical Tips
    • Fast Publishing of Accepted Manuscripts
    • Graphical Abstract Preparation
    • Imaging Protocol Submission
    • Author Policies
  • About Us
    • About AJNR
    • Editorial Board
    • Editorial Board Alumni
  • More
    • Become a Reviewer/Academy of Reviewers
    • Subscribers
    • Permissions
    • Alerts
    • Feedback
    • Advertisers
    • ASNR Home
  • Follow AJNR on Twitter
  • Visit AJNR on Facebook
  • Follow AJNR on Instagram
  • Join AJNR on LinkedIn
  • RSS Feeds

AJNR at ASNR25 | Join us at BOOTH 312 and more. Check out our schedule

Research ArticlePediatricsF

CT for Pediatric, Acute, Minor Head Trauma: Clinician Conformity to Published Guidelines

L.L. Linscott, M.M. Kessler, D.R. Kitchin, K.S. Quayle, C.F. Hildebolt, R.C. McKinstry and S. Don
American Journal of Neuroradiology June 2013, 34 (6) 1252-1256; DOI: https://doi.org/10.3174/ajnr.A3366
L.L. Linscott
aFrom the Mallinckrodt Institute of Radiology (L.L.L., M.M.K., D.R.K., C.F.H., R.C.M., S.D.), Washington University School of Medicine, St. Louis, Missouri
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
M.M. Kessler
aFrom the Mallinckrodt Institute of Radiology (L.L.L., M.M.K., D.R.K., C.F.H., R.C.M., S.D.), Washington University School of Medicine, St. Louis, Missouri
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
D.R. Kitchin
aFrom the Mallinckrodt Institute of Radiology (L.L.L., M.M.K., D.R.K., C.F.H., R.C.M., S.D.), Washington University School of Medicine, St. Louis, Missouri
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
K.S. Quayle
cPediatrics (K.S.Q.), St. Louis Children's Hospital, St. Louis, Missouri.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
C.F. Hildebolt
aFrom the Mallinckrodt Institute of Radiology (L.L.L., M.M.K., D.R.K., C.F.H., R.C.M., S.D.), Washington University School of Medicine, St. Louis, Missouri
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
R.C. McKinstry
aFrom the Mallinckrodt Institute of Radiology (L.L.L., M.M.K., D.R.K., C.F.H., R.C.M., S.D.), Washington University School of Medicine, St. Louis, Missouri
bDepartments of Radiology (R.C.M., S.D.)
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
S. Don
aFrom the Mallinckrodt Institute of Radiology (L.L.L., M.M.K., D.R.K., C.F.H., R.C.M., S.D.), Washington University School of Medicine, St. Louis, Missouri
bDepartments of Radiology (R.C.M., S.D.)
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Figures & Data
  • Info & Metrics
  • Responses
  • References
  • PDF
Loading

Abstract

BACKGROUND AND PURPOSE: In 2001, pediatric radiologists participating in a panel discussion on CT dose reduction suggested that approximately 30% of head CT examinations were performed unnecessarily. With increasing concern regarding radiation exposure to children and imaging costs, this claim warrants objective study. The purpose of this study was to test the null hypothesis that 30% of head CT studies for clinical evaluation of children with acute, minor head trauma do not follow established clinical guidelines.

MATERIALS AND METHODS: Retrospective review of 182 consecutive patients with acute, minor head trauma from February 2009 to January 2010 at a tertiary care children's hospital emergency department was performed, and clinician adherence to published clinical guidelines for children younger than 2 years and children 2–20 years of age was determined. The binomial test was used for a null hypothesis of 30% unnecessary examinations against the actual percentage of head CTs deemed unnecessary on the basis of established guidelines. Statistical testing was performed for children younger than 2 years and 2–20 years of age.

RESULTS: For children younger than 2 years of age, 2 of 78 (2.6%; 95% CI, 0.5%–8.3%) and, for children 2–20 years of age, 12 of 104 (11.5%; CI, 6.4%–18.7%) did not conform to established guidelines. These percentages were significantly less than the hypothesized value of 30% (P < .001).

CONCLUSIONS: Clinician conformity to published guidelines for use of head CT in acute, minor head trauma is better than suggested by a 2001 informal poll of pediatric radiologists.

ABBREVIATIONS:

ALARA
As Low As Reasonably Achievable
CI
confidence interval

Traumatic brain injury is an important clinical problem for children in the United States. Between 2002 and 2006 for children 0–14 years of age, traumatic brain injuries resulted in 473,947 emergency department visits, 35,136 hospitalizations, and 2174 deaths. Of these, approximately 50% were related to falls, and 90% were discharged to home.1 CT of the head plays an increasingly important role in the triage of these patients, as evidenced by the steady nationwide increase in CT use for head trauma during the past decade. The percentage of emergency department visits for head trauma resulting in CT examinations rose steadily from 12% in 1997 to 34% in 2008.2 Increased awareness of the potential long-term hazards of radiation, particularly in children,3⇓–5 has engaged physicians and regulators in attempts to decrease CT use without compromising patient care.6,7

In August 2001, a multidisciplinary group, including 40 pediatric radiologists, gathered for the ALARA conference. While discussing means of lowering the overall CT dose to the pediatric population, the pediatric radiologists were informally asked what percentage of head and body CT examinations were performed unnecessarily. The group suggested that approximately 30% of head CT examinations were performed unnecessarily.8 With increasing concern regarding radiation exposures to children and imaging costs, it is important to determine the extent to which unnecessary CT examinations are being performed. In this study, we retrospectively reviewed CT cases to determine clinician conformity to guidelines for CT examinations for the clinical evaluation of infants and children with acute, minor, closed-head trauma.9,10 The null hypothesis was that 30% of head CT studies for clinical evaluations of infants and children with acute, minor, closed-head trauma do not follow established guidelines.8

Materials and Methods

From 2001 through 2010 for a large tertiary-care children's hospital, data were collected and plots were made for the number of emergency department patients and the number of head CT examinations. For February 2009 to January 2010, retrospective reviews of 1000 consecutive head CT examinations from the emergency department were performed. Our institutional review board reviewed and approved the study.

The clinical presentation of each patient was reviewed to determine the indication for the examination. Of the 1000 head CTs reviewed, 523 were performed for trauma. The emergency department and inpatient records of these 523 patients (n = 127 for 0–24 months of age; n = 396 for 2–20 years of age) with head trauma were reviewed in detail to determine whether the cases met published inclusion criteria (guidelines) for acute, minor, closed-head trauma.9,10 Of these, 78/127 (61%) patients younger than 2 years and 104/396 (26%) patients 2–20 years met the criteria for acute minor head trauma.

We used 2 age-specific clinical guidelines: 0- to 24-month guidelines published in Pediatrics in 2001,9 and 2- to 20-year guidelines published in Pediatrics in 1999.10 Inclusion criteria for the study were the following: 1) head CT scan performed, and 2) patient presenting with acute minor head trauma. “Acute minor head trauma” was defined as an isolated minor closed-head injury occurring in an otherwise neurologically healthy child. Exclusion criteria varied significantly between the 2 published guidelines. The specific exclusion criteria and the number of patients in each category are found below.

Exclusion criteria for the 0- to 24-month algorithm included the following: concern for abuse or neglect during initial evaluation (n = 31), multiple trauma (n = 7), prior outside hospital head CT–prompted evaluation (n = 6), pre-existing neurologic disorder (n = 2), penetrating injury (n = 2), birth trauma (n = 1), bleeding diathesis (n = 0), and previous intracranial surgery (n = 0).9 Exclusion criteria for the 2- to 20-year algorithm included the following: known or suspected cervical spine injury (n = 93), multiple trauma (n = 92), initial evaluation >24 hours after injury (n = 38), suspected intentional head trauma (eg, assault) (n = 34), abnormal mental status at the initial examination or abnormal or focal findings on neurologic examination (n = 32), pre-existing neurologic disorders potentially aggravated by trauma (such as arteriovenous malformations or shunts) (n = 27), loss of consciousness of >1 minute or unobserved loss of consciousness (n = 22), physical evidence of skull fracture (n = 18), prior outside hospital head CT–prompted evaluation (n = 11), presence of drugs or alcohol (n = 4), history of bleeding diatheses (n = 2), or a language barrier (n = 1).10 Of the 292 patients 2–20 years of age who were excluded, 82 had >1 clinical parameter that excluded them from guideline application. If a specific clinical parameter for exclusion from clinical guideline application was not mentioned in the medical record, it was assumed that this parameter was not present. For instance, if concern for abuse or neglect was not explicitly stated in the medical record, it was assumed that no concern existed. No patient was excluded due to deficiencies in the medical record.

The emergency department and inpatient records were evaluated in detail by 2 diagnostic radiology residents in their fourth year of postgraduate training. There was no overlap in record evaluation. The results of CT examinations came exclusively from written reports. Simple skull fracture was defined as a nondepressed fracture with no associated intracranial injury. Intracranial injury was defined as intracranial hemorrhage, contusion, or cerebral edema.

After identifying those patients whose presentation qualified as acute, minor head trauma (n = 127 for 0–24 months of age; n = 396 for 2–20 years of age), these patient records were reviewed to assess whether the emergency department physicians conformed to the published guidelines for appropriate use of CT to evaluate possible intracranial injury. Instances of clinician nonconformity to guidelines were identified, and specific points of departure were recorded. An unnecessary CT was defined as a CT examination performed when imaging was not recommended according to the clinical guideline.

The null hypothesis was that 30% of head CT studies for clinical evaluation of infants and children with acute, minor, closed-head trauma do not follow established guidelines.8 Exact P values for the binomial test were calculated to test this null hypothesis (ie, to determine whether the observed proportion in the population was different from the theoretic value [constant] of 30%). Tests were performed for children younger than 2 years of age and for children 2–20 years of age. The statistical power of the tests was calculated. Blyth-Still-Casella 95% confidence intervals were determined for proportions. Statistical analyses were performed with StatXact-9 Statistical Software for Exact Nonparametric Inference (Cytel, Cambridge, Massachusetts).

Results

In 2001, nine hundred sixty-one head CT examinations were performed in our emergency department. The number of annual examinations increased each year until 2007, with 1453 examinations performed that year. After 2007, the annual number of examinations steadily dropped, with only 956 examinations performed in 2010 (Fig 1). The number of emergency department visits remained steady during this period. No specific emergency or radiology department initiatives to reduce CT use were in place during the time of this study.

Fig 1.
  • Download figure
  • Open in new tab
  • Download powerpoint
Fig 1.

Head CT use (examinations/year) and annual total emergency department visits (×100) at our institution from 2001 to 2010.

Of the 1000 head CT examinations reviewed in our study, we found that most examinations, 523 (52%; Blyth-Still-Casella 95% confidence intervals, 49%–55%), were performed for trauma. In the 0- to 24-month age group, 127/218 (58%; 95% CI, 52%–65%) examinations were performed for trauma, and in the 2- to 20-year age group, 396/770 (51%; 95% CI, 48%–55%) were performed for trauma (Fig 2).

Fig 2.
  • Download figure
  • Open in new tab
  • Download powerpoint
Fig 2.

Breakdown of 1000 head CT examinations performed because of trauma or other causes.

When patient records from all trauma-related CT examinations were reviewed to determine whether the patient qualified for application of the clinical guidelines, we obtained the following results: 78/127(61%; 95% CI, 52%–70%) patients 0–24 months of age qualified for use of the guideline, and 104/396 (26%; 95% CI, 22%–31%) patients 2–20 years of age qualified for use of the guideline.

For ages 0–24 months, nonconformity to clinical guidelines occurred in 2 of 78 (2.6%; 95% CI, 0.5%–8.3%) patients. For patients 2–20 years of age, nonconformity to clinical guidelines occurred in 12 of 104 patients (11.5%; 95% CI, 6.4%–18.7%) (Fig 3). These percentages were significantly less than the hypothesized value of 30% (P < .001). The statistical power of these tests was >99%.

Fig 3.
  • Download figure
  • Open in new tab
  • Download powerpoint
Fig 3.

Percentage of cases in which emergency department clinicians conformed to the diagnostic guidelines.

For ages 0–24 months, results of head CT examinations reported in the medical record are listed in Table 1, with 11 patients presenting with acute minor head trauma having isolated simple skull fractures and 11 patients having intracranial injuries. For ages 2–20 years, CT results are listed in Table 2, with 1 patient presenting with acute minor head trauma having an isolated simple skull fracture and 2 patients having intracranial injuries. An example of a skull fracture with intracranial hemorrhage in a 5-month-old girl is presented in Fig 4.

View this table:
  • View inline
  • View popup
Table 1:

Zero- to 24-month-old patients with minor head trauma who qualified for use of the clinical guidelines: CT imaging findings for acute, minor head trauma

View this table:
  • View inline
  • View popup
Table 2:

Two- to 20-year-old patients with minor head trauma who qualified for use of the clinical guidelines: CT imaging findings for acute, minor head trauma

Fig 4.
  • Download figure
  • Open in new tab
  • Download powerpoint
Fig 4.

CT of the head in a 5-month-old girl who fell 3–4 feet off a bed onto a wooden floor. Parents reported no loss of consciousness or change in behavior. Physical examination revealed a left parietal scalp hematoma. Head CT showed a nondisplaced left parietal bone fracture (black arrow) with small underlying extra-axial fluid collection, likely an epidural hematoma (white arrow).

Discussion

Many physicians, regulators, and patients are concerned that CT is being overused, particularly for pediatric patients for whom risks from ionizing radiation are greater than those in adults.11 Concerns are supported by studies demonstrating increased CT use with time12⇓–14 and/or studies that indicate that the overall diagnostic yield from CT examinations (for specific indications) is decreasing with time.15 Overuse is one of the concerns that have spurred the creation of social media campaigns (such as the Image Gently campaign of the Alliance for Radiation Safety in Pediatric Imaging) to reduce unnecessary imaging procedures that use ionizing radiation.

The head CT rate performed by our emergency department does not support a trend for increasing CT use. The rate has decreased from 1453 in 2007 to 956 in 2010—a 34% reduction even though the emergency department visit rate remained stable during this period. No specific emergency or radiology department initiatives to reduce CT use were in place during the time of this study. While we did not evaluate the percentage of conformity to guidelines for head CT in 2007, we speculate that increased awareness of the risk of CT from campaigns such as Image Gently has reduced the number of unnecessary CT examinations ordered.

In the August 2001 ALARA conference, during a panel discussion session entitled “Helical CT and Cancer Risk,” an informal poll of approximately 40 pediatric radiologists suggested that as many as 30% of body and head CT examinations were performed unnecessarily.8 There are, however, few studies that document clinician conformity to established CT standards of care (such as published guidelines and/or diagnostic algorithms). We, therefore, retrospectively determined the extent to which established guidelines were followed by clinicians who used CT for pediatric acute, minor head trauma and found that >88% of CT examinations conform to CT standards of care. Our findings do not support government agencies, health insurance companies, and radiologists who suggest that head CT is overused for the evaluation of acute, minor head trauma in children. At our institution in the age of Image Gently, conformity to guidelines is high.

On the basis of our study, we think that current guidelines/algorithms for use with CT imaging have limitations. In our study, 75% of 2- to 20-year-old patients with head trauma had conditions (such as unwitnessed injuries or pre-existing neurologic conditions), that excluded them from clinical guideline application. This was not the case for 0- to 24-month-old patients with head trauma, in whom only 39% had presenting symptoms or conditions that excluded them from guideline application. We believe that the disparity between these 2 groups is in the strictness of the exclusion criteria for each guideline; the 2- to 20-year guideline was much stricter in its exclusion criteria. Recently, a prospective cohort study of children with head injury was performed to identify patients at “very low risk of clinically important brain injury,” and guidelines for imaging were brought up-to-date.16 We consider these guidelines less restrictive in the use of CT for the evaluation of acute, minor head trauma than the guidelines used in our study. Many published guidelines do not account for unique patient/environmental factors that must be dealt with by the medical team on a case-by-case basis. Effort should be made to create clinical guidelines that apply to most patients.

There were no poor outcomes in our study. We found that a substantially higher proportion of examinations in the 0- to 24-month age group yielded findings of intracranial injury: 11/78 (14%) versus 2/104 (2%) in the 2- to 20-year age group. This may be due to the insensitivity of clinical factors in identifying intracranial injury in the 0- to 24-month age group and/or an increased predisposition of this age group to intracranial injury in the setting of minor head trauma.17,18 This finding underscores the importance of CT in triaging this young group of patients.

Our study has several weaknesses. Our data were collected from a tertiary care children's hospital and may not be generalizable to emergency departments in other countries, community hospitals, or areas with less access to CT. For instance, in Scandinavia, it was found that that 27% of head CT examinations were unnecessary on the basis of Scandinavian guidelines.19 Another weakness of our study is that it is focused on a single emergency department condition—acute, minor head trauma in infants and children. There may be various degrees of conformity to imaging guidelines for various conditions. For instance, it was recently found that for cervical spine trauma, ≥20% of CT examinations could be avoided if clinical guidelines were followed.20

Conclusions

On the basis of this retrospective study, clinician conformity to published guidelines for use of head CT in acute, minor head trauma is better than suggested by a 2001 informal poll of pediatric radiologists for a tertiary care pediatric children's hospital. While clinical guidelines may be an important tool in ensuring appropriate use of medical imaging, unique patient characteristics often exclude a large proportion of patients from enrollment in diagnostic algorithms. Making guidelines more inclusive should be encouraged.

Footnotes

  • Disclosures: Robert C. McKinstry—UNRELATED: Consultancy: Siemens Healthcare, Comments: I was paid as an actor in a TV commercial “Somewhere in America” featuring the Siemens PET/MRI scanner, Travel/Accommodations/Meeting Expenses Unrelated to Activities Listed: Siemens Healthcare, Comments: presented work done with the PET/MRI scanner at May 2012 symposium of the International Society for Magnetic Resonance in Medicine. Steven Don—UNRELATED: Consultancy: Siemens, Payment for Lectures (including service on Speakers Bureaus): Siemens honorarium (approximately $2000, less some expenses) for a talk at a Siemens meeting in July 2011 regarding digital radiography unrelated to this CT publication, Patents (planned, pending, or issued): Carestream Health, Comments: image-noise simulator software patent unrelated to this CT publication. Carestream Health purchased the patent.

  • Paper previously presented at: American Society of Neuroradiology Annual Meeting and the Foundation of the ASNR Symposium, April 21–26, 2012; New York New York.

REFERENCES

  1. 1.↵
    1. Faul M,
    2. Xu L.,
    3. Wald MM,
    4. et al
    . Traumatic Brain Injury in the United States: Emergency Department Visits, Hospitalizations and Deaths, 2002–2006. Atlanta, Georgia: Centers for Disease Control and Prevention; 2010
  2. 2.↵
    1. Larson DB,
    2. Johnson LW,
    3. Schnell BM,
    4. et al
    . Rising use of CT in child visits to the emergency department in the United States, 1995–2008. Radiology 2011;259:793–801
    CrossRefPubMed
  3. 3.↵
    1. Frush DP,
    2. Donnelly LF,
    3. Rosen NS
    . Computed tomography and radiation risks: what pediatric health care providers should know. Pediatrics 2003;112:951–57
    Abstract/FREE Full Text
  4. 4.↵
    1. Brenner DJ,
    2. Hall EJ
    . Computed tomography: an increasing source of radiation exposure. N Engl J Med 2007;357:2277–84
    CrossRefPubMed
  5. 5.↵
    1. Smith-Bindman R
    . Is computed tomography safe? N Engl J Med 2010;363:1–4
    CrossRefPubMed
  6. 6.↵
    International Atomic Energy Agency. Dose Reduction in CT while Maintaining Diagnostic Confidence: A Feasibility/Demonstration Study. IAEA-TECDOC-1621. Vienna, Austria: International Atomic Energy Agency; 2009
  7. 7.↵
    1. Brenner DJ,
    2. Hricak H
    . Radiation exposure from medical imaging: time to regulate? JAMA 2010;304:208–09
    CrossRefPubMed
  8. 8.↵
    1. Slovis TL,
    2. Berdon WE
    . Panel discussion. Pediatr Radiol 2002;32:242–44
    CrossRef
  9. 9.↵
    1. Schutzman SA,
    2. Barnes P,
    3. Duhaime AC,
    4. et al
    . Evaluation and management of children younger than two years old with apparently minor head trauma: proposed guidelines. Pediatrics 2001;107:983–93
    Abstract/FREE Full Text
  10. 10.↵
    The management of minor closed head injury in children: Committee on Quality Improvement, American Academy of Pediatrics. Commission on Clinical Policies and Research, American Academy of Family Physicians. Pediatrics 1999:104:1407–15
    Abstract/FREE Full Text
  11. 11.↵
    Committee on the Biological Effects of Ionizing Radiation. Health Effects of Exposure to Low Levels of Ionizing Radiation. BEIR V. Washington, DC: National Academy Press; 1990
  12. 12.↵
    1. Gonzales JM
    . Imaging professionals' beliefs on overutilization of CT and MRI exams. Radiol Manage 2011;33:41–46
    PubMed
  13. 13.↵
    1. Armao D,
    2. Semelka RC,
    3. Elias J Jr.
    . Radiology's ethical responsibility for healthcare reform: tempering the overutilization of medical imaging and trimming down a heavyweight. J Magn Reson Imaging 2012;35:512–17
    CrossRefPubMed
  14. 14.↵
    1. Hendee WR,
    2. Becker GJ,
    3. Borgstede JP,
    4. et al
    . Addressing overutilization in medical imaging. Radiology 2010;257:240–45
    CrossRefPubMed
  15. 15.↵
    1. Weir ID,
    2. Drescher F,
    3. Cousin D,
    4. et al
    . Trends in use and yield of chest computed tomography with angiography for diagnosis of pulmonary embolism in a Connecticut hospital emergency department. Conn Med 2010;74:5–9
    PubMed
  16. 16.↵
    1. Kuppermann N,
    2. Holmes JF,
    3. Dayan PS,
    4. et al
    . Identification of children at very low risk of clinically-important brain injuries after head trauma: a prospective cohort study. Lancet 2009;374:1160–70
    CrossRefPubMed
  17. 17.↵
    1. Gruskin KD,
    2. Schutzman SA
    . Head trauma in children younger than 2 years: are there predictors for complications? Arch Pediatr Adolesc Med 1999;153:15–20
    CrossRefPubMed
  18. 18.↵
    1. Greenes DS,
    2. Schutzman SA
    . Occult intracranial injury in infants. Ann Emerg Med 1998;32:680–86
    CrossRefPubMed
  19. 19.↵
    1. Heskestad B,
    2. Baardsen R,
    3. Helseth E,
    4. et al
    . Guideline compliance in management of minimal, mild, and moderate head injury: high frequency of noncompliance among individual physicians despite strong guideline support from clinical leaders. J Trauma 2008:65:1309–13
    CrossRefPubMed
  20. 20.↵
    1. Griffith B,
    2. Bolton C,
    3. Goyal N,
    4. et al
    . Screening cervical spine CT in a level I trauma center: overutilization? AJR Am J Roentgenol 2011;197:463–67
    CrossRefPubMed
  • Received March 19, 2012.
  • Accepted after revision August 23, 2012.
  • © 2013 by American Journal of Neuroradiology
View Abstract
PreviousNext
Back to top

In this issue

American Journal of Neuroradiology: 34 (6)
American Journal of Neuroradiology
Vol. 34, Issue 6
1 Jun 2013
  • Table of Contents
  • Index by author
Advertisement
Print
Download PDF
Email Article

Thank you for your interest in spreading the word on American Journal of Neuroradiology.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
CT for Pediatric, Acute, Minor Head Trauma: Clinician Conformity to Published Guidelines
(Your Name) has sent you a message from American Journal of Neuroradiology
(Your Name) thought you would like to see the American Journal of Neuroradiology web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Cite this article
L.L. Linscott, M.M. Kessler, D.R. Kitchin, K.S. Quayle, C.F. Hildebolt, R.C. McKinstry, S. Don
CT for Pediatric, Acute, Minor Head Trauma: Clinician Conformity to Published Guidelines
American Journal of Neuroradiology Jun 2013, 34 (6) 1252-1256; DOI: 10.3174/ajnr.A3366

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
0 Responses
Respond to this article
Share
Bookmark this article
CT for Pediatric, Acute, Minor Head Trauma: Clinician Conformity to Published Guidelines
L.L. Linscott, M.M. Kessler, D.R. Kitchin, K.S. Quayle, C.F. Hildebolt, R.C. McKinstry, S. Don
American Journal of Neuroradiology Jun 2013, 34 (6) 1252-1256; DOI: 10.3174/ajnr.A3366
del.icio.us logo Twitter logo Facebook logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One
Purchase

Jump to section

  • Article
    • Abstract
    • ABBREVIATIONS:
    • Materials and Methods
    • Results
    • Discussion
    • Conclusions
    • Footnotes
    • REFERENCES
  • Figures & Data
  • Info & Metrics
  • Responses
  • References
  • PDF

Related Articles

  • No related articles found.
  • PubMed
  • Google Scholar

Cited By...

  • No citing articles found.
  • Crossref (7)
  • Google Scholar

This article has been cited by the following articles in journals that are participating in Crossref Cited-by Linking.

  • CT Dose Optimization in Pediatric Radiology: A Multiyear Effort to Preserve the Benefits of Imaging While Reducing the Risks
    Taylor J. Greenwood, Rodrigo I. Lopez-Costa, Patrick D. Rhoades, Juan C. Ramírez-Giraldo, Matthew Starr, Mandie Street, James Duncan, Robert C. McKinstry
    RadioGraphics 2015 35 5
  • Measuring appropriateness of diagnostic imaging: a scoping review
    Felix Walther, Maria Eberlein-Gonska, Ralf-Thorsten Hoffmann, Jochen Schmitt, Sophia F. U. Blum
    Insights into Imaging 2023 14 1
  • Deciding why and when to use CT in children: a radiologist’s perspective
    Donald P. Frush
    Pediatric Radiology 2014 44 S3
  • Evaluation of management and guideline adherence in children with mild traumatic brain injury
    Merel C. Broers, Jikke-Mien F. Niermeijer, Irene A.W. Kotsopoulos, Hester F. Lingsma, Jos F.M. Bruinenberg, Coriene E. Catsman-Berrevoets
    Brain Injury 2018 32 8
  • The Think A-Head campaign: an introduction to ImageGently 2.0
    Donald P. Frush, Lee S. Benjamin, Nadia Kadom, Charles G. Macias, Sally K. Snow, Sarah J. Gaskill, Emilee Palmer, Keith J. Strauss
    Pediatric Radiology 2016 46 13
  • Meeting the Needs for Radiation Protection
    Donald P. Frush
    Health Physics 2017 112 2
  • Neuroimaging Rates for Closed Head Trauma in a Community Hospital
    Steven M. Rothman, Sarah W. Alander
    Pediatric Emergency Care 2018 34 2

More in this TOC Section

  • SyMRI & MR Fingerprinting in Brainstem Myelination
  • Comparison of Image Quality and Radiation Dose in Pediatric Temporal Bone CT Using Photon-Counting Detector CT and Energy-Integrating Detector CT
  • Dual-Layer Detector CT for PEDS Image Quality
Show more Pediatrics

Similar Articles

Advertisement

Indexed Content

  • Current Issue
  • Accepted Manuscripts
  • Article Preview
  • Past Issues
  • Editorials
  • Editor's Choice
  • Fellows' Journal Club
  • Letters to the Editor
  • Video Articles

Cases

  • Case Collection
  • Archive - Case of the Week
  • Archive - Case of the Month
  • Archive - Classic Case

More from AJNR

  • Trainee Corner
  • Imaging Protocols
  • MRI Safety Corner

Multimedia

  • AJNR Podcasts
  • AJNR Scantastics

Resources

  • Turnaround Time
  • Submit a Manuscript
  • Submit a Video Article
  • Submit an eLetter to the Editor/Response
  • Manuscript Submission Guidelines
  • Statistical Tips
  • Fast Publishing of Accepted Manuscripts
  • Graphical Abstract Preparation
  • Imaging Protocol Submission
  • Evidence-Based Medicine Level Guide
  • Publishing Checklists
  • Author Policies
  • Become a Reviewer/Academy of Reviewers
  • News and Updates

About Us

  • About AJNR
  • Editorial Board
  • Editorial Board Alumni
  • Alerts
  • Permissions
  • Not an AJNR Subscriber? Join Now
  • Advertise with Us
  • Librarian Resources
  • Feedback
  • Terms and Conditions
  • AJNR Editorial Board Alumni

American Society of Neuroradiology

  • Not an ASNR Member? Join Now

© 2025 by the American Society of Neuroradiology All rights, including for text and data mining, AI training, and similar technologies, are reserved.
Print ISSN: 0195-6108 Online ISSN: 1936-959X

Powered by HighWire