Children with minor head trauma do not generally require hospitalization
MedWire News: Children with minor blunt head trauma who have normal computed tomography (CT) scan results are at very low risk for subsequent traumatic findings or neurosurgical intervention and do not require hospitalization, suggest study findings.
"We now have definitive evidence supporting discharging most neurologically normal children with head trauma after negative CT scans home from the Emergency Department," said study author James Holmes from the University of California Davis School of Medicine in the USA.
"Sending these patients home with their parents not only provides good, safe care but it also saves costs. It is a win for everyone concerned," he added.
Writing in the Annals of Emergency Medicine, the researchers report results from an observational cohort study of 13,543 children (younger than 18 years) who experienced minor blunt head trauma and were seen at 25 centers in the USA between 2004 and 2006.
The children all had an initial Glasgow Coma Scale (GCS) score of 14 or 15, indicating minor or negligible brain injury, and a normal emergency department CT scan result.
In total, 2485 children were hospitalized including 2107 with a GCS score of 15 and 378 with a GCS score of 14. Of these, 6.0% had a subsequent CT or magnetic resonance imaging (MRI) scan, from which 0.6% had abnormal results. None of the hospitalized children required neurosurgical intervention due to their accident.
The other 11,058 children were discharged home with their parents from the emergency department. Successful telephone or mail follow-up was collected for 8756 of these children. The results of the follow-up showed that 2.00% of the discharged children had a subsequent CT or MRI scan, 0.05% had abnormal CT/MRI results following the scan, and no children required neurosurgical intervention.
"One of the goals in the evaluation of children with minor head trauma is to try to avoid CT scan use, if possible," said study co-author Nathan Kuppermann also from the University of California Davis School of Medicine. "If you do a CT scan and the scan is negative, and the child is well, then for goodness sakes let the child go home."
He commented: "Admitting these children after normal CT scans is costly, causes them to spend time away from their families and loved ones, and potentially exposes them to other health risks, such as hospital-borne infections."
The authors conclude that their results suggest that most children with blunt head trauma who have a GCS score of 14 or 15 and a normal CT scan result can be discharged from hospital and observed at home by their parents, as they are at extremely low risk for subsequent abnormal scan results or neurosurgical intervention.
They concede that there may be exceptions to this rule, for example, children with other comorbidities or who are taking anticoagulant medication, so advise caution when applying it.
MedWire (www.medwire-news.md) is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2011
By Helen Albert