Rules established by the Pediatric Emergency Care Applied Research Network (PECARN) validate the use of CT scans for high-risk cases, those occurring from certain falls, being struck by an object or getting injured in a vehicle accident when not wearing a safety helmet. PECARN also identifies low-risk cases when a child can be sent home without a CT scan.
"CT scanning is a very powerful tool for ERs, but we have to be wiser as to which patient needs the neuro-imaging," said Nigrovic, who is also assistant professor of pediatrics at Harvard Medical School in Boston.
In the study, researchers found 5,433 children were observed before a decision on CT use was made, and 3,744 (69 percent) were discharged without a scan. Of these, 26 returned for scans, which detected trauma in four children, but only one significant brain injury.
Of the 34,680 children in a no-observation group, 22,532 (65 percent) were discharged from the ER without a CT, and 81 later returned for a scan. Of these, three had traumatic findings, none significant.
The CT use rate was 31.1 percent in children who were observed, compared to 35 percent for those who were not observed before a decision on CT use was made. Both groups had similar trauma rates, the authors noted.
Dr. Wally Ghurabi, medical director of the emergency department at Santa Monica-UCLA Medical Center and Orthopedic Hospital, said the use of CT scans for children often depends on where the ER is located and the expectations of the parents and local pediatrician.
"This has been a very hot topic for the last two to three years," said Ghurabi, whose ER has a protocol on CT scans for children. Under the program, a child who is not high-risk receives a physical exam, a non-narcotic painkiller, is made comfortable and is checked regularly by a staff nurse, after which a reevaluation is made.
"There's no question that a six-hour observation period is an e
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