Low risk of neurosurgical intervention for children with normal CT scan after minor head trauma
MONDAY, June 27 (HealthDay News) -- Children with minor blunt head injury with normal initial computed tomography (CT) scan results and a Glasgow Coma Scale (GCS) score of 14 to 15 are very unlikely to need neurosurgical intervention, according to a study published online June 17 in the Annals of Emergency Medicine.
James F. Holmes, M.D., M.P.H., from the University of California Davis School of Medicine in Sacramento, and colleagues assessed the frequency of neurologic complications in children evaluated in the emergency department with minor blunt head trauma. A total of 13,543 children younger than 18 years, with blunt head trauma, who had an initial GCS score of 14 or 15 and a normal CT scan were included. Follow-up of 2,485 hospitalized patients assessed neurologic outcomes, and the 11,058 patients discharged home from the emergency department were followed up via telephone or mail to assesses subsequent neuroimaging, neurologic complications, or neurosurgical interventions.
The investigators found that, of the patients discharged to home, 197 children (2 percent) underwent subsequent CT or magnetic resonance imaging (MRI); five had abnormal results, but none of them required surgical intervention. Among hospitalized patients, 137 (6 percent) received further CT scan/MRI; 16 had abnormal results, but none of them required neurosurgical intervention. For children with a normal initial CT scan and GCS score of 14 or 15, the negative predictive value for neurosurgical intervention was 100 percent.
"Children with initial emergency department GCS of 14 to 15 and normal cranial CT scan results after blunt head trauma are at very low risk for subsequent traumatic findings on CT or MRI scan and at extremely low risk of needing neurosurgical intervention," the authors write.
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