New Decision Rule Reduces Use of Cranial CT in Pediatric Patients
A multi-institutional research team investigated an alternate approach to assess pediatric patients with minor closed-head trauma. The group reported the effort and findings in the Archives of Pediatric and Adolescent Medicine.
Four Level 1 Pediatric Trauma Centers participated in the effort (Brown University, George Washington University, Ottawa Hospital Research Institute, and University of Rochester Medical Center). The prospective observational study examined 1000 patients. All the patients underwent cranial CT to assess disease.
The mean age of the participants was 8.9 years. Of the cohort, 6.5 percent (65 children) had positive findings from CT studies. Of those 65 patients, six went on to undergo neurosurgical intervention. The team worked to create a decision rule that could limit the use of CT in these cases.
The team determined a rule to predict intracranial injury which included sensory deficit, mental status change, age less than two years, evidence of basilar skull fracture, dizziness, Glasgow Coma Scale under 15, injury related to bicycle, and defect of the skull on examination.
The decision rule proposed had a sensitivity of 95.4 percent, 48.9 percent specificity, and a negative predictive value of 99.3 percent. Prediction of disease based on physical examination and history had a sensitivity of 14.8 percent, alternatively.
The team suggests that the rule proposed should only be applied in certain cases. They specify use of the decision rule as a tool to help determine if patients require additional assessment with CT. They additionally note the importance of follow-up for children who have negative CT findings but still present with symptoms.
June 6, 2008 Related topics: Imaging, Diagnostic, Pediatrics