Head trauma CT may be unnecessary for children with bleeding disorders
MedWire News: Children with bleeding disorders do not require computed tomography (CT) scans after head trauma in the absence of signs or symptoms of intracranial hemorrhage (ICH), suggest US clinicians.
The team found that patients with an acquired or congenital bleeding disorder were twice as likely to undergo routine CT imaging as children without a disorder, but were not significantly more likely to experience intracranial hemorrhage (ICH).
The study compared CT use and ICH detection in 43,904 patients aged less than 18 years who attended an emergency room with blunt head trauma. In all, 230 of the children had a hereditary bleeding disorder, such as hemophilia, or an acquired disorder due to use of anticoagulation or thrombocytopenia. All children with a bleeding disorder had a Glasgow Coma Scale (GCS) score of 14 or 15, indicating minor brain injury.
Compared with children without bleeding disorders but with a similar GCS, those with a bleeding disorder were 2.29 times more likely to undergo CT imaging, which was performed at the discretion of the admitting doctor.
However, the rate of ICH did not significantly differ between the two groups, affecting two (1.1%) of the 186 scanned children with bleeding disorders compared with 655 (4.4%) of the 14,969 scanned children with no such disorder.
"The two patients with bleeding disorders and ICH had signs and symptoms suggestive of ICH, which would have warranted cranial CT evaluation," comment Lois Lee (Children's Hospital, Boston, Massachusetts) and co-authors in the Journal of Pediatrics.
They emphasize that no children with a bleeding disorder who had negative ICH results in the emergency department CT scan subsequently had a positive CT scan. Furthermore, none of the children with bleeding disorders who did not undergo CT in the emergency department had a positive CT scan during follow-up.
Lee et al therefore conclude: "Although patients with congenital or acquired bleeding disorders are at risk for ICH, the low rate of ICH suggests that they may not routinely require cranial CT imaging after minor blunt head trauma in the absence of signs or symptoms of ICH."
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By Lynda Williams