High number of unnecessary CT scans associated with pediatric sports-related head trauma

July 29, 2015, GYMR

Visits to emergency departments by children with sports-related head injuries have skyrocketed in the past decade, and new research finds that many patients undergo unnecessary computed tomography or CT scans that expose them to radiation and increase the cost of treatment. Fifty-three percent of patients studied received a CT scan, but only four percent of those actually had traumatic brain injuries (TBIs) on their CT scans. The new study was published online in the American Journal of Emergency Medicine.

"Research highlighting the risk of exposure to radiation from CT scans has prompted efforts to reduce variability in care by developing prediction rules to decrease inappropriate CT scan use in children with blunt head trauma, while reducing healthcare costs," said Todd Glass, MD, Division Chief of Emergency Medicine at Nemours Children's Hospital and lead author of the study. "There is an opportunity for injury-prevention efforts in high-risk sports, and opportunities to reduce CT scan use in general by use of evidence-based prediction rules."

TBI is the leading cause of disability in children one year and older, and is a leading cause of pediatric death. The Centers for Disease Control and Prevention recently estimated that more than 2.6 million children 18 years or younger are treated in emergency departments for sports and recreation-related injuries, with approximately 6.5 percent being severe enough to be TBIs. CT scans can identify TBIs, but often don't catch milder and concussions.

Researchers studied 23,000 cases of children ages five to 18 who were admitted to 25 emergency departments in hospitals associated with the Pediatric Emergency Care Applied Research Network (PECARN) over a two-year period. This was a subanalysis of a large study of more than 40,000 head injured studied in PECARN led by Dr. Nathan Kuppermann of UC Davis Medical Center, and previously published in the Lancet. Key findings from the research include certain sports are far more likely to result in serious TBIs, with the highest rates found in equestrian events, snow sports such as skating, skiing, sledding, and snowboarding, and wheeled sports such as rollerblading, skateboarding and scooter use.

Those wheeled sports, for example, had a hospitalization rate 10 times higher than that of team sports, according to researchers, who suggested that particular attention should be paid to injury prevention and protective gear in the highest-risk sports.

"When looking at what influences the physician's decision to conduct a CT scan on a pediatric patient with a sports-related head injury, outside actors like concern from parents, coaches or other members of the care team influence the decision," said Glass. "From our research, we encourage physicians to follow evidence-based criteria when considering conducting a CT scan on this patient population, such as those provided by the PECARN TBI prediction rules, while also considering the risk of particular sports to reduce unnecessary medical interventions."

Approximately 14 percent of the total injuries were -related, and in those cases, researchers found that CT scans were conducted on 53 percent, or 1,743 patients, while only 69 of them had suffered from TBIs. A large percentage of the patients who received CT scans were actually at low risk and could have been observed for a period of time prior to deciding whether a CT was really necessary, the study said.

Explore further: Picture emerges of how kids get head injuries

More information: Todd Glass, Richard M. Ruddy, Elizabeth R. Alpern, Marc Gorelick, James Callahan, Lois Lee, Mike Gerardi, Kraig Melville, Michelle Miskin, James F.Holmes, Nathan Kuppermann. "Traumatic Brain Injuries and Computed Tomography Use in Pediatric Sports Participants." The American Journal of Emergency Medicine. Web (July 6, 2015)

Related Stories

Picture emerges of how kids get head injuries

November 12, 2014
A study in which more than 43,000 children were evaluated for head trauma offers an unprecedented picture of how children most frequently suffer head injuries, report physicians at Washington University School of Medicine ...

Observation in the ER can reduce CT scans in kids

August 6, 2013
The longer a child with minor blunt head trauma is observed in the emergency department, the less likely the child is to require computed tomography (CT) scan, according to the results of a study published online Friday in ...

Study reveals potentially unnecessary radiation after suspected sports-related injury

May 5, 2014
A new study of Utah youth with suspected sports-related head injuries found that emergency room visits for children with sports-related head injuries have increased since the state's concussion law passed in 2011, along with ...

Emergency room visits for kids with concussions skyrocketing

September 30, 2013
Researchers report a skyrocketing increase in the number of visits to the emergency department for kids with sports-related traumatic brain injuries (TBI), such as concussions.

Needless abdominal CT scans can be avoided in children, study says

February 1, 2013
A study of more than 12,000 children from emergency departments throughout the country in the Pediatric Emergency Care Applied Research Network (PECARN) has identified seven factors that can help physicians determine the ...

Neuroimaging findings generally nondiagnostic in kids with sports-related concussions

June 2, 2015
Researchers from the Canada North Concussion Network in Manitoba examined neuroimaging studies obtained in children and adolescents with sports-related concussions and found that the images appeared normal in 78% of cases. ...

Recommended for you

Tongue-in-cheek Nobels honor nutritional analysis of cannibalism, roller-coaster kidney stones treatment

September 14, 2018
A nutritional analysis of cannibalism and treating kidney stones on roller-coasters were research projects honored by tongue-in-cheek awards at Harvard University Thursday, designed to make you laugh first, and think later.

Pediatric robot patient offers new level of realism for doctors in training

September 10, 2018
A team of researchers and engineers at Gaumard Scientific has unveiled a new robot that raises the bar on medical training devices. The robot, called HAL, has been made to look like a five-year-old male patient and offers ...

Why men say they've had more lifetime sexual partners than women

July 25, 2018
The disparity between the number of sexual partners reported by men and women can largely be explained by a tendency among men to report extreme numbers of partners, and to estimate rather than count their lifetime total, ...

Censors jump into action as China's latest vaccine scandal ignites

July 22, 2018
Chinese censors on Sunday deleted articles and postings about the vaccine industry as an online outcry over the country's latest vaccine scandal intensified.

Revenge of a forgotten medical 'genius'

June 30, 2018
It's not an uncommon fate for a pioneering scientist: languishing unrecognised in his time before dying in obscurity. But as his 200th birthday approaches, the life-saving work of a Hungarian obstetrician is finally getting ...

Yes, you can put too much chlorine in a pool

June 2, 2018
(HealthDay)—Before you take a dip in the pool this summer, be sure there's not too much chlorine in the water.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.