Should a CT Scan Be Done After Head Trauma?

     A previous article discussed the risk of radiation in children. Doctors have always been concerned about exposing their pediatric patients to X-rays and that concern is growing as we become more aware of the increased risk of cancer caused by even one CT scan of the head. As with all dilemmas in medicine, doctors and parents must choose between the risk of the procedure (cancer) and the risk of not doing the procedure – in this case, it is the risk of missing a significant brain injury.

     There are a number of factors that doctors and parents can look at to determine whether a child with a head trauma needs to have a CT scan of the head. If the mechanism of the trauma is more violent or severe, such as a motor vehicle accident in which another passenger was killed or ejected or the vehicle rolled over, the risk of brain injury is higher. If a pedestrian or bicyclist is struck by a motor vehicle, or the patient’s head was struck by a high-impact object, the patient is also at higher risk. Falls from higher than 3 feet for children under 2 years old or 5 feet for children under 5 years are more dangerous. If there is visible swelling and bruising of the scalp that is in an area other than the forehead, the trauma is potentially severe. If the child was unconscious immediately after the accident or if there is any confusion or change of consciousness after the accident, the child is at greater risk. Finally, if there is severe headache or vomiting after head trauma, there is increased risk that the child has brain injury.

     If a child with head trauma did not lose consciousness and has none of the factors mentioned above, the risk that he has significant brain trauma is lower than the risk involved with a CT scan. He should be closely observed to see if any of the more serious symptoms develop.

     As we strive to protect our children from unnecessary X-ray exposure, it is important for parents to keep a good record of any procedure done on their child. An imaging record for parents is available on-line at: www.imagegently.org .