Can a CT be Omitted in Pediatric Minor Head Trauma?: A Comment

Can a CT be Omitted in Pediatric Minor Head Trauma?: A Comment

Thank you very much for the critical review of our study. However, we do not think that a computed tomography (CT) scan can be skipped in every patient with minor head trauma. The definition of “pediatric minor head trauma” has been well-defined and based on current literature review and guidelines.[1] An urgent radiological approach can be obligatory in selective cases. In Table 1 of our study, we listed high and intermediate risk groups of traumatic brain injury which require a CT scan. Out of 214 patients, 3 children were diagnosed with a traumatic intracranial injury, one of them requiring a neurosurgical intervention.

We absolutely agree with Andrade et al that there must be “more careful indications for cranial CT scans in children with minor head trauma.”[2] Our indications for cerebral CT scans in children are even more restrictive than one of the best validated clinical decision rules (the Pediatric Emergency Care Applied Research Network [PECARN]).[3] [4]

Possible unknown underlying bleeding disorders are a critical point and should be integrated in clinical decision rules. We agree, that underlying medical disorders must be part of the diagnostic work-up (SAMPLE – patient assessment).[5] Previously known coagulopathies should lead to a high suspicion of intracranial injury and early radiological work-up in symptomatic patients.

• References

• 1 Maguire JL, Boutis K, Uleryk EM, Laupacis A, Parkin PC. Should a head-injured child receive a head CT scan? A systematic review of clinical prediction rules. Pediatrics 2009; 124 (01) e145-e154
• 2 Andrade FP, Montoro R, Oliveira R. , et al. Pediatric minor head trauma: do cranial CT scans change the therapeutic approach?. Clinics (Sao Paulo) 2016; 71 (10) 606-610
• 3 Schutzman SA, Barnes P, Duhaime AC. , et al. Evaluation and management of children younger than two years old with apparently minor head trauma: proposed guidelines. Pediatrics 2001; 107 (05) 983-993
• 4 Dunning J, Daly JP, Lomas JP, Lecky F, Batchelor J, Mackway-Jones K. ; Children's head injury algorithm for the prediction of important clinical events study group. Derivation of the children's head injury algorithm for the prediction of important clinical events decision rule for head injury in children. Arch Dis Child 2006; 91 (11) 885-891
• 5 Marx J. Rosen's Emergency Medicine: Concepts and Clinical Practice. 7th ed. Philadelphia: Mosby/Elsevier; 2010: 267