Head CT after mild paediatric head injury remains common, most in adult hospitals

Design

Retrospective descriptive analysis of National Trauma Data Bank, 2017 to 2023

Population

12,030 children with isolated mild traumatic brain injury

Primary outcome

Annual head CT rates by hospital type

Effect

CT use 43.5% to 51.5% overall; adult hospitals 59.5%, mixed 44.0%, paediatric 38.8%

This retrospective analysis of National Trauma Data Bank hospitals from 2017 to 2023 covered 12,030 children with isolated mild traumatic brain injury. About a third were treated at adult hospitals (32.1%), 31.6% at paediatric hospitals and 36.2% at mixed hospitals.

Head CT use ranged from 43.5% to 51.5% across the years with little change. It was highest in adult hospitals (59.5%), then mixed (44.0%) and paediatric hospitals (38.8%). CT use was higher with lower Glasgow coma scores, impaired consciousness, and in non-teaching or smaller hospitals.

This is descriptive. It shows variation, not which scans were unnecessary, because trauma registry data lack the clinical decision-rule details that would classify each case.

• Use a validated paediatric decision rule before imaging a child with minor head injury.
• Adult and smaller hospitals scanned more often than paediatric centres.
• Do not use this study to say a given scan was unnecessary; clinical detail was limited.
• Document the reasons for imaging in the notes.

Why it matters

Radiation exposure in children is a cumulative concern, and care varies with the hospital's type.

Don't overread it

A trauma-registry sample of treated children does not represent all children with minor head injury.

The statistics, in plain English

A rate of 59.5% at adult hospitals against 38.8% at paediatric centres shows variation but not appropriateness. The sample is children treated at trauma-registry hospitals, so it may not match all children seen with minor head injury.

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