Too Many CT Scans Ordered For Children with Concussions, Says New Study

Monday, October 13, 2014

Pediatricians continue to order far more CT scans (CTs) than necessary to evaluate children for concussions, according to a new study.

Researchers from Cincinnati Children’s Hospital Medical Center found that for patients at low risk of bleeding from the brain after a head injury but who have concussion symptoms, pediatricians were more likely to refer to the emergency department and request CTs one day after the injury than in the first few hours after the injury. The study will be presented Oct. 13 at the annual meeting of the American Academy of Pediatrics in San Diego.

“It is generally agreed that if children are one day out from an injury, it is highly unlikely they will need head CT scans, especially in low-risk cases where they have normal physical exams,” says Wendy Pomerantz, MD, an emergency medicine physician at Cincinnati Children’s and the study’s lead author.

Dr. Pomerantz and her colleagues developed an online survey asking pediatricians how they would manage three concussion scenarios. In all scenarios, children were at low-risk of intracranial injury, did not lose consciousness and had normal physical exams. The scenarios involved:

• A 14-year-old patient who sees a doctor the day of injury with headache, nausea and amnesia.
• A 9-year-old patient who sees a doctor the day after injury with headache and nausea.
• A 16-year-old patient who sees a doctor five days after injury with nausea and dizziness.

The researchers found that 14 percent were referred to the emergency department in the first scenario. Forty percent were referred in the second scenario, and 27 percent were referred in the third scenario. In the vast majority of these cases, patients did not need to be referred for emergency care and a CT scan, according to Dr. Pomerantz.

The relatively higher radiation doses associated with CT, compared to most other imaging exams, have raised concerns over an increase in risks associated with radiation exposure. This is particularly true in children, whose organs are more sensitive to the effects of radiation than those of an adult.

“Further professional education about concussion management and limiting CT scans is clearly necessary,” says Dr. Pomerantz.

About Cincinnati Children’s

Cincinnati Children’s Hospital Medical Center ranks third in the nation among all Honor Roll hospitals in U.S.News & World Report’s 2014 Best Children’s Hospitals. It is also ranked in the top 10 for all 10 pediatric specialties. Cincinnati Children’s, a non-profit organization, is one of the top three recipients of pediatric research grants from the National Institutes of Health, and a research and teaching affiliate of the University of Cincinnati College of Medicine. The medical center is internationally recognized for improving child health and transforming delivery of care through fully integrated, globally recognized research, education and innovation. Additional information can be found at www.cincinnatichildrens.org. Connect on the Cincinnati Children’s blog, via Facebook and on Twitter.