الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Head trauma occurs commonly in childhood. Most head trauma in children is minor and not associated with brain injury or long-term sequelae. However, a small number of children who appear to be at low risk may have a clinically important traumatic brain (ciTBI) injury.
The clinical challenge for evaluating minor head trauma in pediatric patients is to identify those infants and children with ciTBI while limiting unnecessary radiographic imaging and radiation exposure. Neuroimaging, usually with computed tomography (CT), is highly sensitive for identifying brain injury requiring acute intervention. However, individual clinical predictors for ciTBI are often nonspecific, particularly in young children. Thus, evaluation for high risk findings and the use of a clinical decision rule can provide a balanced approach that identifies almost all infants and children with ciTBI after minor head trauma without overuse of CT.
Most infants and children with minor head trauma can be safely discharged home after careful evaluation without undergoing imaging. If neuroimaging is performed, those patients with normal clinical findings and imaging may also be discharged home.
The aim of this study was to detect the overuse of CT scans, based on personal clinical judgement of emergency physician after minor blunt head injury (mild TBI) among pediatric patients in the ED.
In this prospective observational study, we enrolled 50 pediatric patients (2-18 years) with minor blunt head trauma at ED. All patients were radiologically investigated using CT. Then, interpretations were confirmed with the attending neurosurgeon. All enrolled patients were followed up during their stay until referral to another department or discharge. The measured outcome was the presence of clinically important traumatic brain injury (ciTBI) according to CT findings.
Results showed that, clinical judgement alone was associated with 30% increase in using CT scans in all enrolled patients. While PECARN tool was associated with only 2% increase. Regarding the ability to rule out the need for brain CT scan, clinical judgement was not a statistically significant tool (p =0.574). PECARN rule was a statistically significant excellent tool to rule out the need for CT (AUC= 0.939, 95% CI: 85.6-100) (p < 0.0001). It showed a good sensitivity (88.2%) and specificity (97.0). Its negative predictive value (NPV) was 94.1%.