To CT or not to CT? Low risk head injury in kids

CT scanning of kids has been on the rise, though we recognize the limitations of this test. It’s not perfect and has some real costs (money, time, sedation risk, cancer). Who do we need to CT and who can we get away without scanning? The Pediatric Emergency Care Research Network (PECARN) looked at a paltry 42,412 kids and came up with a pretty good tool. It still needs external validation, but 42-thousand?! Wow.

They provide you with a flowchart you can share with parents to help make an educated decision. Click for the PDF file for the episode which includes this flow chart and a copy of the video notes.

Couple this with the information on harm from CT, so perfectly compiled by David Newman and Ashley Shreeves into this Consent form for getting CT’s (yes, CT’s have danger associated with them so they advocate patient’s actually signing a consent after you explain the risks). In order to have an intelligent conversation with your patients, you should know the numbers and they’re included on this form.

Test your knowledge

What would you do with these patients? And why?

  1. 18 month old who fell off a 4′ high bed, but is acting normally.
  2. 48 month old sister who fell off the same 4′ bed and is acting normally. Correct answers include the doctor saying, “No more monkeys jumping on the bed!”
  3. A 13 month old girl whose mom tripped over an extension cord while carrying the baby. Now the baby cries whenever she comes her hair.
  4. 3 year old who was hit by a bicyclist and hit his head on the concrete. He’s acting normally but vomited once.
  5. A 2 month old who rolled off a couch onto the hardwood floors. No LOC and no vomiting, but mom says she’s not acting right. She looks fine to you. Whatever, mom!
  6. A 26-month old who fell down 5 wooden steps and blacked out initially. He now reports his head has an owie.
  7. A 16 month old who ran at full speed into the kitchen cabinet. He’s crying and has a huge forehead hematoma.


  1. Jenn says:

    The handy note sheet is a great summary of the study — I will definitely be printing out a copy to keep in my white coat. I especially appreciate the statistics so that parents and doctors together can make an informed decision about the care of the child.

  2. JB says:

    I love what you are doing with this blog. It’s a helpful supplement to emergency medicine education which is at the level to many other well known blogs out there.

    Keep up the good work, I will definitely keep following.

    1. Rahul says:

      Thanks for the kind words!

  3. Jeff says:

    Nice summary of a study. I am having some trouble accessing the paired PDF however.

  4. Nisha B. says:

    Having trouble opening the PDF link. I can tell this would be helpful keeping in our white coats – esp if we’re going into Peds 🙂 This was an extremely helpful video – Now I know when I can tell parents the benefit of the CT outweighs the risk of cancer.

Leave a Comment

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s