A significant portion of children with seemingly minor head trauma do not need a CT scan, a UC Davis study released Monday has concluded.
"A lot of times parents go in with their kids and they're expecting a CT scan," said Dr. Sandra Gorges, the study's co-author. "That's not necessarily a good thing. You need to stop and think, 'Is this going to help me?' "
In the most extensive study on children's head trauma and CT scans to date, lead author Dr. Nathan Kuppermann, the University of California, Davis, Medical School's emergency medicine chairman, and his colleagues analyzed more than 42,000 patients under 18 with apparently minor head trauma in 25 hospitals nationwide.
The study found that 20 percent of children over 2 with apparently minor head trauma and almost 25 percent younger than 2 were at very low risk of serious brain damage, rendering the CT scan unnecessary.
Giving such children a CT scan has a minuscule chance of catching a serious brain injury, and that benefit is outweighed by the dangers of exposing children to radiation, Kuppermann concluded.
The study also has implications for controlling health care costs, because a CT scan generally costs upward of $1,000.
"It looks like CT scans are being overused," Kuppermann said. "While cost was not the motivating factor in our study, it seems that CT scans are being used inefficiently."
The UC Davis researchers identified a subgroup for whom there was virtually no risk of serious brain injury.
The researchers used information from this group to identify six indicators for which children have very low risk of serious brain injury.
The six factors include acting normally, not having lost consciousness, no signs of skull fracture and no severe mechanism of injury, such as a car crash.
The researchers then tested these factors on a second group: Of the nearly 5,000 children who were identified to be at very low risk, only two had serious brain injury.
In recent years, experts have expressed concern over radiation from CT scans, especially in children.
Use of CT scans doubled from 1995 to 2005.
Children "are more susceptible to radiation damage than adults," Gorges said.
One 2001 study estimated that roughly one in 1,100 children who receive CT scans may eventually die from a cancer caused by excess radiation.
Another study released last month found that medical imaging tests expose more than 4 million Americans under age 65 to high doses of radiation. CT scans accounted for half the total radiation amount.
In addition, the UC Davis study found dramatic variation in CT usage among hospitals, which is evidence that recommendations are necessary, according to Kuppermann.
"The rates of CT scan usage were all over the place," he said. "But we aren't trying to tell physicians what to do. We're trying to provide evidence with which physicians and families can make informed decisions regarding appropriate use of CT scans."
Call The Bee's Anna Tong, (916) 321-1045.
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