Hospitalization after Head Trauma not Necessary, if CT Scans are OK

According to a recent large-scale national study, most children taken to the emergency room (ER) with minor blunt head trauma do not require hospitalization for observation if they have normal computed tomography (CT) scans.

As a general practice, children who are brought to the ER with blunt head trauma are often are admitted to the hospital for further observation in order to undergo recurrent neurologic examinations. The study authors, however, stated that based on their findings, "hospitalization of children with minor head trauma after normal CT scan results for neurologic observation is generally unnecessary." The study was sponsored by the Pediatric Emergency Care Applied Research Network (PECARN).

The 13,543 children participating in the study were all reported to be eighteen years old or younger, with a median age of nine years old; 63% of the participants were boys.

They were all treated for minor blunt head trauma in twenty-five different emergency departments across the United States from June 2004 to September 2006. The study included both children with isolated head trauma and head trauma, along with other injuries.

The authors of the study acquired initial CT results for each patient and deemed that the participants were considered to have normal CT scans if their radiological scans did not reveal intracranial hemorrhage, cerebral edema, cerebral concussion, or skull fractures.

Roughly 80% of the study participants who were discharged from the ER were contacted for follow-up either by telephone or mail at least one week after their visit in order to find out if they received additional CT or MRI scans. Children who underwent hospitalization were followed during their hospitalization for any deterioration. The participant’s families were also questioned concerning neurologic complications, including neurosurgical interventions.

The researchers discovered that less than 1% of children participating in the study had subsequent abnormal CT scans or MRIs, and none required neurosurgical intervention. This, the researchers determined, indicated that there was a very low risk for the children to deteriorate after the initial normal cranial CT scan.

"We now have definitive evidence supporting discharging most neurologically normal children with head trauma after negative CT scans home from the Emergency Department," said the study's lead author and co-investigator James Homes, professor of emergency medicine in the UC Davis School of Medicine. "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."

The authors noted that some of the participants who were hospitalized may have been kept for injuries not confined to the head; also, some children may have been vomiting, and as such were admitted for intravenous fluid administration.

Of the patients hospitalized, though, over 50% suffered solely from blunt head trauma, as no other injuries or ailments were reported; they were most likely hospitalized purely for neurologic observation.

Blunt head trauma is the leading cause of death in children older than one year old, so there is still concern to be had over children and head trauma.

The authors, however, reported that the findings of this study show that children suffering from minor blunt head trauma with normal CT scans are at a very low risk for subsequent traumatic findings on neuroimaging. Further, such children are at a tremendously low risk of needing 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. 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," said study senior author Nathan Kuppermann, professor of pediatrics and emergency medicine and chair of the Department of Emergency Medicine in the UC Davis School of Medicine.

"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," Kuppermann continued.

However, studies in adults have found that neurological problems following minor blunt head trauma are rare and that hospitalization after a normal cranial CT scan is unnecessary.

This study is published online in the Annals of Emergency Medicine.