When to Use Imaging in Pediatric Sport-Related Head Injury

August 21, 2015

CT scans for children with head injuries from sports should not be routine practice.

Imaging is not always necessary for children who have sports-related head injuries, according to a study published in the American Journal of Emergency Medicine.

Researchers from the Feinberg School of Medicine in Chicago, IL and The Children’s Hospital of Philadelphia in Pennsylvania sought to determine the spectrum of injuries and trends in CT use in the Pediatric Emergency Care Applied Research Network (PECARN).

"Research highlighting the risk of exposure to radiation from CT scans has prompted efforts to reduce variability in care by developing prediction rules to decrease inappropriate CT scan use in children with blunt head trauma, while reducing health care costs," lead author Todd Glass, MD, Division Chief of Emergency Medicine at Nemours Children's Hospital, said in a release. "There is an opportunity for injury-prevention efforts in high-risk sports, and opportunities to reduce CT scan use in general by use of evidence-based prediction rules."

The study took place over a two-year period and included 23,082 children, aged five to 18, who had presented to one of 25 emergency departments with complaints of head trauma related to a sport. The hospitals were associated with the Pediatric Emergency Care Applied Research Network (PECARN). The study’s outcomes included frequency of CT, traumatic brain injuries (TBIs) on CT, and clinically important TBI (ciTBIs), as defined by:[[{"type":"media","view_mode":"media_crop","fid":"40613","attributes":{"alt":"","class":"media-image media-image-right","id":"media_crop_6724401006598","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"4193","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"float: right;","title":"Todd Glass, MD","typeof":"foaf:Image"}}]]

Death

Neurosurgery

Intubation longer than 24 hours

Hospitalization for two nights or longer

The findings showed that 3,289 of the children (14%) had a sport-related head trauma. Of these:

2% had Glasgow Coma Scale scores less than 14

53% received ED CTs

4% had TBIs on CT

1% had ciTBIs

The researchers noted that equestrians had increased adjusted odds or CTs, with a rate of TBI on CT of 4%. When the researches compared team sports, those associated with snow and non-motorized wheeled sports had an increased adjusted odds of ciTBIs.

"When looking at what influences the physician's decision to conduct a CT scan on a pediatric patient with a sports-related head injury, outside actors like concern from parents, coaches or other members of the care team influence the decision," Glass explained in the release. "From our research, we encourage physicians to follow evidence-based criteria when considering conducting a CT scan on this patient population, such as those provided by the PECARN TBI prediction rules, while also considering the risk of particular sports to reduce unnecessary medical interventions."