Is cranial computerized tomography really necessary for infants with minor head trauma?

Abstract

Objective: It is quite difficult to evaluate the necessity of cranial computerized tomography (CT) in children with minor head trauma (MHT) under two years old. We aimed to draw attention to the unnecessary cranial CT performance and the cost caused by these unnecessary CT's.Materials and Methods: The medical registry of 100 patients who applied to our emergency department (ED) between December 2008 and October 2009 were investigated retrospectively. The inclusion criteria were patients <= 2 years old, with GKS= 15, who had fallen from a height of <= 1m and having normal neurological examination.Results: 51% were girls and 49% were boys, total of 100 cases, with a mean age of 13.66 months. Crying/uneasiness was the most frequent symptom at admission (67%), vomiting was the second symptom with frequency of 19%. Abrasion was the most frequent finding (39%). Cranial CT was performed on 70% of patients. There were no pathological findings in 25 (83.3%) patients who were evaluated with CT, there were pathological findings in only 5 (16.7%) patients. Linear fractures were found in 4 (80%) and linear fracture and subarachnoid hemorrhage was found in 1 (20%). There was no necessity for operation in any of these patients evaluated with cranial CT. Finally, these patients were called by telephone in 48 hours after they had applied to the ED, of whom only 47% could be reached. None of these patients had complaints and did not apply to the ED with recurrent symptoms.Conclusion: Cranial CT is unnecessary in most infants with MHT.