Pediatric traumatic brain injury and radiation risks: A clinical decision analysis

Kara E. Hennelly, Rebekah Mannix, Lise E. Nigrovic, Lois K. Lee, Kimberly M. Thompson, Michael C. Monuteaux, Mark Proctor, Sara Schutzman

Research output: Contribution to journalArticlepeer-review

29 Scopus citations

Abstract

Objective: To determine the optimal imaging strategy for young children with minor head injury considering health-related quality of life and radiation risk. In children with minor head trauma, the risk of missing a clinically important traumatic brain injury (ciTBI) must be weighed against the risk of radiation-induced malignancy from computed tomography (CT) to assess impact on public health. Study design: We included children <2 years old with minor blunt head trauma defined by a Glasgow Coma Scale score of 14-15. We used decision analysis to model a CT-all versus no-CT strategy and assigned values to clinical outcomes based on a validated health-related quality of life scale: (1) baseline health; (2) non-ciTBI; (3) ciTBI without neurosurgery, death, or intubation; and (4) ciTBI with neurosurgery, death, or intubation >24 hours with probabilities from a prospective study of 10 000 children. Sensitivity analysis determined the optimal management strategy over a range of ciTBI risk. Results: The no-CT strategy resulted in less risk with the expected probability of a ciTBI of 0.9%. Sensitivity analysis for the probability of ciTBI identified 4.8% as the threshold above which CT all becomes the preferred strategy and shows that the threshold decreases with less radiation. The CT all strategy represents the preferred approach for children identified as high-risk. Conclusion: Among children <2 years old with minor head trauma, the no-CT strategy is preferable for those at low risk, reserving CT for children at higher risk.

Original languageEnglish
Pages (from-to)392-397
Number of pages6
JournalJournal of Pediatrics
Volume162
Issue number2
DOIs
StatePublished - Feb 2013

Keywords

  • AIS
  • Abbreviated Injury Scale
  • CT
  • Clinically important traumatic brain injury
  • Computed tomography
  • ED
  • Emergency department
  • GCS
  • Glasgow Coma Scale
  • PECARN
  • Pediatric Emergency Care Applied Research Network
  • Probability of clinically important traumatic brain injury
  • TBI
  • Traumatic brain injury
  • ciTBI
  • p(ciTBI)

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