UMEM Educational Pearls

Category: Pediatrics

Title: To CT or not to CT, Part I

Keywords: head CT, trauma, pediatrics, head injury (PubMed Search)

Posted: 2/4/2011 by Adam Friedlander, MD
Click here to contact Adam Friedlander, MD

Head injuries in children under 2yo are stress provoking, particularly with regard to when you should be getting a head CT.  Luckily, a large (42,412 children, 10,718 <2yo) multi-center trial exists to guide your behavior.

In children <2yo, if the following criteria are met, there is a near 0% (95% CI) chance of a clinically important traumatic brain injury (defined as an injury requiring intervention):
  • normal mental status
  • no non-frontal scalp hematoma
  • no loss of consciousness, or LOC <5s
  • non-severe injury mechanism
  • no palpable skull fracture
  • acting normally according to the parents
Approximately 25% of the patients who had CTs, fit the low risk criteria above, and none had clinically significant brain injuries.  
In other words, just follow these simple rules to cut down the number of head CTs done on children <2yo by 25%.



Kuppermann NHolmes JFDayan PS, et al. Identification of children at very low risk of clinically-important brain injuries after head trauma: a prospective cohort study. Lancet2009;374:1160-1170