caution is vital when it comes to ct scans for pediatric patients

When children report to the local emergency room after having suffered some sort of serious head trauma that rendered them unconscious, the go-to treatment for many physicians is to order a computed tomography scan.

While a CT scan is invaluable in that it can provide a physician with a very clear picture as to whether a particular pediatric patient is suffering from brain bleeding necessitating immediate surgical intervention, it is not without its own set of concerns.

Paramount among these concerns is the small, but not statistically insignificant, long-term cancer risk posed by the intense ionizing radiation used in a standard CT scan. Indeed, one study found that, depending upon the age of the child, a single CT scan of the head is the functional equivalent of 140 chest x-rays.

Accordingly, physicians must take the dangers posed by radiation exposure from a CT scan into consideration when deciding how to treat children who may have suffered a traumatic brain injury that could result in permanent damage — or even death — if misdiagnosed.

While this may seem like something of an impossible determination, a recently published study in the medical journal JAMA Pediatrics may provide at least some guidance going forward.

Here, researchers from the University of California-Davis Health System and Boston Children’s Hospital examined the cases of over 40,000 children examined for head trauma in emergency rooms across the nation whose only reported symptom was a temporary loss of consciousness.

Here, they found that among children who were otherwise alert in the emergency room and showed none of the other head injury symptoms identified by the Pediatric Emergency Care Applied Research Network (abnormal mental functioning, vomiting, scalp hematoma, etc.), the risk of clinically significant traumatic brain injuries was a mere 0.5 percent.

“Children with clinically important brain injuries rarely have loss of consciousness alone, and almost always present other symptoms, such as vomiting or showing signs of neurological problems,” said one of the primary authors. “Being able to make treatment decisions backed by strong data helps doctors and parents feel better about deciding whether further testing is really needed.”

In other words, the study enables physicians and parents to feel more confident about holding off on a CT scan and waiting to see if a child, who only lost consciousness as a result of trauma to the head, shows any more symptoms indicative of a life-threatening TBI.

This study is indeed eye opening and may serve to be influential in shaping how physicians test for TBIs in children going forward.

As such, parents in these situations will want to keep a very close eye on their children and immediately report any additional observed signs of a TBI. Furthermore, they should know that if the treating physician fails to order the necessary tests after missing a telltale TBI-related symptom and this failure proves harmful to their child, that they do have options for seeking justice.

Source: Rocklin and Roseville Today, “Study: CT scans carry cancer risk for young patients,” July 7, 2014

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