International study of emergency department care for pediatric traumatic brain injury and the role of CT scanning

Objects: Our objective was to investigate the use of CT and its relationshi p to head injury severi ty and age. Method: The multi-center group Internat ional Study of Head Injury Project (ISHIP) serves as the administrative bod y for research design, data collection and analysis. This is a nonrandomize d prospective study of longitudinal outcomes following examination and care in emergency department in five different countries. The subjects of our s tudy were 4,690 children from birth to 15 years of age, all of whom were sy stematically evaluated. Each child was medically evaluated and categorized as to injury severity, mechanism of injury and findings on X-ray and CT sca n. Follow-up interview and assessment was completed for comparison with the presenting clinical state. Results: CT scans were performed for 674 (14.3% ) of the children: 438 scans were normal and 236 were abnormal(P <0.001). O f the children with abnormal CT scans, 23.3% had mild head injuries, 42.7% had moderate injuries, and 33.8% had severe injuries, as determined by the GCS. By age, 10.5% of the positive CTs were in children aged 0-2 years, 56. 3% in 3- to 9-year-olds, and 33% in 10- to 15-year-olds; only in 2% of case s were both CT and X-ray positive. Conclusions: The majority of children di d not need significant medical intervention. Physicians ordered X-ray inves tigations more frequently than CT scanning. The use of X-ray to decide whet her or not CT is necessary is not warranted. The implications of positive C Ts in mild or moderate injuries were most noteworthy, as were age-related i nteractions with positive CT findings.