Reasons for Ordering a Computed Tomography Scan and Abnormalities Found in Pediatric Intermediate-Risk Mild Head Trauma

Objective: To analyze the reasons for ordering a CT scan and the abnormalities identified in children with mild head trauma classified as intermediate-risk according to the PECARN rule. Methods: This retrospective observational study included patients aged 3 months to 14 years who presented to the emergency department (ED) of a tertiary hospital between 2021 and 2022 with mild head trauma classified as intermediate-risk. Two multivariable analyses were performed to identify demographic and clinical factors associated with CT scan utilization and CT abnormalities. Results: We included 555 patients; 40% were girls, and the median age was 4 years (interquartile range: 1 to 8 y). Most patients (98.6%) were managed as outpatients after a median ED stay of 4.5 hours (IQR: 4 to 6.75). CT scans were performed in 78 patients (14.1%), of whom 24 (30.8%) had abnormalities: 13 had traumatic brain injuries and 11 had isolated skull fractures. Six patients (1.1%) had clinically important traumatic brain injuries (ciTBI). Four independent factors were associated with CT scan utilization: number of vomiting episodes (OR: 1.31; 95% CI: 1.16-1.49), headache (OR: 2.1; 95% CI: 1.21-3.6), abnormal behavior reported by parents (OR: 3.45; 95% CI: 1.99-5.95), and time elapsed before being seen by an ED physician (OR: 1.05; 95% CI: 1.01-1.08). Two factors were associated with CT abnormalities: younger age (OR: 0.82; 95% CI: 0.71-0.95) and severe injury mechanism (OR: 5.89; 95% CI: 2.04-18.37). Conclusions: In children with mild head trauma classified as intermediate-risk, the factors leading to CT scan utilization differ from those associated with CT abnormalities. Further studies are needed to confirm these findings.