According to your website, at the AAP meeting, evidence was presented suggesting that among the many children who receive CTs in the ER after head trauma, only seven percent actually have an injury inside the skull. So, how do you know whom to CT and whom not to CT?

Dr. Greene’s Answer:

We want to CT children when the expected health benefit is clearly greater than the tiny increased risk of eventual cancer. To do this, we want to use other signs and symptoms to help decide which children are the most likely to have an important injury inside the skull.

The CT scan is intended to help solve the mystery of what is going on inside the body: When used properly, I would still expect that many children who receive CTs will turn out to be well. Nevertheless, it is wonderful whenever we can use other clues to remove children from the ‘mystery’ group without the amount of radiation exposure needed for a CT scan.

After suffering severe traumatic injury to the head, we would likely all agree that a child would benefit from detailed imaging of the extent of injury to the skull and brain. The controversy arises when deciding how to treat children who have sustained a minor trauma, or “mild traumatic brain injury.”

Research so far suggests that after a relatively minor head trauma the most important kids to scan include those who are dizzy or who have changes in vision or behavior (including everything from excessive sleepiness to vomiting, to seizures). Children under 2 are also good candidates. They are at high risk and often can’t tell us if they are experiencing vision changes or dizziness. Those whose injuries were obtained at great force – such as those in bicycle accidents – are also in the high risk group of internal head injuries, as are those in whom a skull fracture has been found.

Read More From This Series:
CT Scan Defined
CT Scan, Ultrasound or MRI?
CT Scan Safety
CT Scans and Radiation Exposure
CT Scan Risks
Higher Risks in Children
Who Should Receive a CT Scan?
X-Ray or a CT Scan?
Alternatives to a CT Scan
When Should a CT Scan be Performed?
Important Tip to Reduce to Radiation
Questions to Ask before Every CT Scan
Other Radiation Exposures
Measures That Radiologists Should Adhere to When Administering a CT Scan
CT Scans and Cancer
When are MRIs not Practical?
What is Ionizing Radiation?
Who are Radiologists?

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