CT for mild paediatric head injury: still half of children, and six in ten in adult hospitals

Design

Retrospective national trauma registry study, 2017–2023

Population

12,030 children with isolated mild traumatic brain injury

Primary outcome

Head CT use by hospital type

Effect

Overall 43.5–51.5%; adult 59.5% vs mixed 44.0% vs paediatric 38.8%

A retrospective study in Pediatrics (23 September) used the US National Trauma Data Bank to examine 12,030 children with isolated mild traumatic brain injury treated at adult, paediatric or mixed trauma hospitals from 2017 to 2023.

Each year 43.5% to 51.5% had a head CT, with little change over seven years despite national guidance. CT use was 59.5% in adult hospitals, 44.0% in mixed hospitals and 38.8% in paediatric hospitals. Scanning was also more common in non-teaching and smaller hospitals, and in children with lower GCS or impaired consciousness.

This is descriptive and cannot say how many scans were unnecessary. But the gap between adult and paediatric centres, treating the same injury, is hard to explain by case mix alone. Most children with mild head injury are seen first where adults are, and that is where decision rules matter most.

• Apply PECARN to every child with a minor head injury and document it
• Offer observation rather than CT for intermediate-risk children where safe
• Build the rule into triage and ordering pathways in general and adult emergency departments
• Explain the radiation trade-off to parents, who often expect a scan

Why it matters

Children injured near an adult hospital are more likely to be scanned, and each scan carries a small lifetime cancer risk.

Don't overread it

This registry study describes CT use; it cannot judge which individual scans were unnecessary.

The statistics, in plain English

The figures are annual proportions with bootstrap confidence intervals; the key comparison is between hospital types. Because the registry records trauma-centre admissions, less severe cases seen and discharged elsewhere are under-represented, which may overstate CT rates relative to all mild injuries.

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