Correlation between Presenting Symptoms and the Yield of Head CT after Traumatic Brain Injury

Objective: To evaluate potential predictive factors for presence of intracranial injury (ICI) in children presenting to the emergency department (ED) with mild traumatic brain injury (mTBI).

Methods: We retrospectively evaluated pediatric ED cases of head trauma, who underwent CT scans, between the years 2015-2019, in Padeh Poria Medical Center.

From each record we extracted epidemiological data, mechanism of injury, clinical presentation, CT findings and management.

Results: A total of 302 pediatric patients were studied. Mean age was 4.99 ± 3.71 years. Male patients (64.9%) were dominant and falls (82.78%) were the most common mechanism. ICI was found in 71 patients (23.5%), 65 (91.5%) had fractures and 28 (39.4%) had an intracranial hemorrhage.

Among these, 37 (52.1%) transferred to a different hospital, 27 (38%) admitted to our facility and 7 (0.9%) released home.

Analysis of ages 5-13 years (n=153) showed 85% of CT scans had no yield.

Presence of hematoma (p=0.008), vomiting\nausea (p=0.029), rhinorrhea\otorrhea (p=0.011) were significantly more common with ICI.

When hematoma was present, it increased the likelihood for ICI by 3.4 times in ages 0-13 (p=0.0002) and by 5.1 times in ages 5-13 (p=0.017).

Conclusion: We found that most head CT scans for pediatric mTBI had no yield.

When discussing ages 5-13 years, presence of hematoma, vomiting\nausea, rhinorrhea\otorrhea or combination of these can support the use of a CT scan.

Because hematoma was present in most ICI (63 of 71 cases), its absence in the right clinical settings, can perhaps enforce the decision to avoid a head CT scan.