How to Reduce Unnecessary CT Scans in Kids

Rachael Rettner
February 1, 2013

Children are especially vulnerable to the effects of radiation from CT scans, and the results of a new study may give doctors more information to help them determine which kids don't need a scan.

The study involved more than 12,000 children who arrived at the emergency department with trauma to their torso, from a car or bike accident, for example.

The researchers identified seven signs and symptoms that were linked to a child's risk of harmful internal injuries, which might require a CT scan to diagnose.

Children who did not have any of these red flags were at very low risk of having internal injuries that required treatment, the researchers said. So, for most of these children, a CT scan would likely not be useful, the researchers added.

The seven signs were evidence of trauma on the abdomen, such as seat-belt marks; evidence of trauma on the chest; complaints of abdominal pain; neurological changes; abdominal tenderness; abnormal breath sounds; and vomiting. Kids without any of these signs had just a 0.1 chance of having an internal injury that required medical attention, the researchers said.

"We have now identified a population of pediatric patients that does not typically benefit from a CT scan, which is an important step in reducing radiation exposure," said study researcher James Holmes, a professor of emergency medicine at the University of California, Davis School of Medicine.

Looking for the seven signs and symptoms, and identifying kids who don't have any of them, may reduce unnecessary CT scans in children, the researchers said. In the study, 23 percent of CT scans were done unnecessarily on children who had none of the risk factors, the researchers said. [See Too Many CT Scans for Kids Knocked on the Head.]

The researchers stress that just because a child has one of these symptoms does not mean he or she definitely needs a CT scan. In fact, if doctors ordered CT scans every time a child had one of the red flags, the use of CT scans would actually increase, Holmes said.

Instead,  even if a child has one of the seven red flags, doctors should use their judgment in deciding whether or not a CT scan is needed. Doctors may consider observing a child for a period of time in the emergency department or use findings from lab tests or ultrasound imaging to help make a decision.

The study will be published in an upcoming issue of the journal Annals of Emergency Medicine.

Pass it on: Researchers have identified seven signs in injured children that may determine whether or not they need a CT scan.

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