Of the more than 13,500 children included in the study, less than 1 percent had subsequent abnormal CT scans or MRIs and none required neurosurgical intervention.
The study was conducted under the auspices of the groundbreaking Pediatric Emergency Care Applied Research Network (PECARN). It is published online today in the Annals of Emergency Medicine.
"We now have definitive evidence supporting discharging most neurologically normal children with head trauma after negative CT scans home from the Emergency Department," said James Homes, professor of emergency medicine in the UC Davis School of Medicine and the study's lead author and co-investigator.
"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."
While blunt head trauma is the leading cause of death in children older than 1 year old, the authors said the finding shows that children with minor blunt head trauma with normal CT scans are at very low risk for subsequent traumatic findings on neuroimaging. More importantly, they are at extremely low risk of needing neurosurgical intervention.
Nevertheless, children fitting this profile frequently are admitted to hospitals for additional observation following normal CT scans. The study authors conclude that "hospitalization of children with minor head trauma after normal CT scan results for neurologic observation is generally unnecessary."
"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 said.
Kuppermann is founding chair and a principal investigator of PECARN, the first federally funded pediatric emergency research network in the country, and oversees the Academic Centers Research Node. In addition to UC Davis, the group includes hospitals in Milwaukee, Wis.; Philadelphia, Penn.; St. Louis, Mo.; Cincinnati, Ohio and Salt Lake City, Utah. He also is the lead investigator of the PECARN head injury study published in the Lancet in 2009, from which the current study is derived.
Children often are admitted to the hospital for additional observation after blunt head trauma to allow frequent neurologic examinations. 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.
Enrolled in the study were 13,543 children 18 years old or younger with minor blunt head trauma who were treated in 25 emergency departments across the United States from June 2004 to September 2006. The patients' median age was about 9 years old; 63 percent were boys. The study included both children with "isolated head trauma" and head trauma and other injuries.
For the study, the authors obtained initial CT results for each patient. Study participants were considered to have normal CT scans if their radiological scans did not reveal intracranial hemorrhage, cerebral concussion, cerebral edema, or skull fractures. Those who were discharged from the emergency department received follow-up telephone calls at least one week after their emergency department visit, to determine whether their child received additional CT or MRI scans. Their families also were asked about neurologic complications, including neurosurgical interventions. Nearly 80 percent of the study participants were reached for follow-up either by telephone or mail. Those who were hospitalized were followed during their hospitalization for any deterioration.
Hundreds of the patients who were either hospitalized or discharged were found to have received repeated neuroimaging — either CT scans or MRIs or both —but none of the patients required neurosurgical intervention, indicating that there is a very low risk for patients to deteriorate after an initially normal cranial CT scan.
The authors said that the children involved in the study may have required hospitalization for injuries that were not confined to the head, and some also may have been vomiting and so admitted for intravenous fluid administration. But of the patients hospitalized, more than half only had blunt head trauma and no other injuries or ailments, and most were likely hospitalized simply for neurologic observation.
Other study authors include Dominic A. Borgialli of the University of Michigan; Frances M. Nadel of the University of Pennsylvania; Kimberly S. Quayle and Shireen M. Atabaki of Washington University; Neil Schambam of Newark Beth Israel School of Medicine; Art Cooper and Peter S. Dayan of Columbia University; Jeff E. Schunk and Michelle L. Miskin of the University of Utah; and John Hoyle of Michigan State University.
The study and PECARN are funded by the U.S. Department of Health and Human Services' Health Resources and Services Administration/Maternal and Child Health Bureau, Division of Research, Training, and Education, and the agency's Emergency Medical Services for Children.
The UC Davis School of Medicine is among the nation's leading medical schools, recognized for its research and primary-care programs. The school offers fully accredited master's degree programs in public health and in informatics, and its combined M.D.-Ph.D. program is training the next generation of physician-scientists to conduct high-impact research and translate discoveries into better clinical care. Along with being a recognized leader in medical research, the school is committed to serving underserved communities and advancing rural health. For more information, visit UC Davis School of Medicine at medschool.ucdavis.edu Program.
Chronic stress induces fatal organ dysfunctions via a new neural circuit
21.08.2017 | Hokkaido University
New malaria analysis method reveals disease severity in minutes
14.08.2017 | University of British Columbia
Whether you call it effervescent, fizzy, or sparkling, carbonated water is making a comeback as a beverage. Aside from quenching thirst, researchers at the University of Illinois at Urbana-Champaign have discovered a new use for these "bubbly" concoctions that will have major impact on the manufacturer of the world's thinnest, flattest, and one most useful materials -- graphene.
As graphene's popularity grows as an advanced "wonder" material, the speed and quality at which it can be manufactured will be paramount. With that in mind,...
Physicists at the University of Bonn have managed to create optical hollows and more complex patterns into which the light of a Bose-Einstein condensate flows. The creation of such highly low-loss structures for light is a prerequisite for complex light circuits, such as for quantum information processing for a new generation of computers. The researchers are now presenting their results in the journal Nature Photonics.
Light particles (photons) occur as tiny, indivisible portions. Many thousands of these light portions can be merged to form a single super-photon if they are...
For the first time, scientists have shown that circular RNA is linked to brain function. When a RNA molecule called Cdr1as was deleted from the genome of mice, the animals had problems filtering out unnecessary information – like patients suffering from neuropsychiatric disorders.
While hundreds of circular RNAs (circRNAs) are abundant in mammalian brains, one big question has remained unanswered: What are they actually good for? In the...
An experimental small satellite has successfully collected and delivered data on a key measurement for predicting changes in Earth's climate.
The Radiometer Assessment using Vertically Aligned Nanotubes (RAVAN) CubeSat was launched into low-Earth orbit on Nov. 11, 2016, in order to test new...
A study led by scientists of the Max Planck Institute for the Structure and Dynamics of Matter (MPSD) at the Center for Free-Electron Laser Science in Hamburg presents evidence of the coexistence of superconductivity and “charge-density-waves” in compounds of the poorly-studied family of bismuthates. This observation opens up new perspectives for a deeper understanding of the phenomenon of high-temperature superconductivity, a topic which is at the core of condensed matter research since more than 30 years. The paper by Nicoletti et al has been published in the PNAS.
Since the beginning of the 20th century, superconductivity had been observed in some metals at temperatures only a few degrees above the absolute zero (minus...
16.08.2017 | Event News
04.08.2017 | Event News
26.07.2017 | Event News
21.08.2017 | Materials Sciences
21.08.2017 | Health and Medicine
21.08.2017 | Materials Sciences