Young Children with A Minor Traumatic Head Injury: Clinical Observation or CT Scan?

Purpose: In young children with minor traumatic head injuries (MTHI) classified as intermediate risk (IR) either clinical observation or computed tomography (CT) scan is recommended. In this study we describe clinicians’ choice and which factors contribute to this decision. Methods: This was a planned sub-study of a prospective multicentre observational study that enrolled 1,006 children younger than 18 years with MTHI who presented to six emergency departments in The Netherlands. Results: Of those, 280 children classified as IR group fulfilling one or more minor criteria, leaving the clinician with the choice between clinical observation or a CT scan. In our cohort 228/280 (81,4%) children were admitted for clinical observation, 15/280 (5,4%) received a CT scan, 6/280 (2,1%) received a CT scan and were admitted for observation, and 31/280 (11,1%) children were discharged from the emergency department without any intervention. Three objective factors were found in favour for a CT scan; namely age above two years, the presence of any loss of consciousness (LOC) and presentation on weekend days. Conclusion: In children with MTHI in an IR group, clinicians prefer clinical observation above performing a CT scan.