@article{article_1656016, title={Selective Computed Tomography Use in Pediatric Head Trauma: Clinical Challenges and Recommendations for Children Under Two Years}, journal={Harran Üniversitesi Tıp Fakültesi Dergisi}, volume={22}, pages={364–373}, year={2025}, DOI={10.35440/hutfd.1656016}, author={Şimşek, Mustafa and Avsarogullari, Ömer Levent and Demir, Hüseyin Avni and Hasözhan, Ali}, keywords={Pediatrik Kafa Travması, Bilgisayarlı Tomografi, PECARN Kılavuzları, Acil Servis, Radyasyon Maruziyeti}, abstract={Background: Head trauma in children under two years of age is a significant public health concern frequently encountered in emergency departments. Due to the unique anatomical and physiological characteristics of this age group, accurate clinical evalua-tion and appropriate management remain challenging. This study aimed to examine the epidemiological characteristics, clinical presentations, imaging practices, and clinical outcomes of pediatric head trauma cases in this vulnerable age group. Additionally, it assessed adherence to established international clinical guidelines and sought to provide practical suggestions to minimize the unnecessary use of computed tomography (CT) imaging.
Materials and Methods: In this retrospective observational study, medical records of 2,074 pediatric patients aged 0–24 months who presented to the emergency department of a tertiary care training and research hospital with head trauma between January 1, 2015, and December 31, 2015, were analyzed. Data collected included patient demographics, mechanisms of injury, clinical findings, Glasgow Coma Scale (GCS) scores, indications for CT imaging and results, and clinical follow-up information. All data were analyzed using descriptive statistics, logistic regression, and receiver operating characteristic (ROC) curve analysis.
Results: Falls were the most common mechanism of injury, accounting for 64.6% of cases. CT scans were performed in 64.6% of the patients; however, clinically significant intracranial injuries were detected in only 10.4%. Loss of consciousness (OR=1.75) and scalp hematoma (OR=1.62) were identified as the strongest independent predictors of positive CT findings. ROC analysis demonst-rated moderate predictive performance (AUC=0.72), indicating that clinical assessment alone provides limited accuracy in guiding imaging decisions.
Conclusions: Despite well-established international guidelines, CT scans continue to be overused in pediatric head trauma cases among children under two years of age. Implementing structured clinical decision tools such as the Pediatric Emergency Care Applied Research Network (PECARN) criteria, along with targeted educational programs for healthcare providers and parents, is critical to minimizing unnecessary radiation exposure, enhancing patient safety, and improving clinical outcomes. Future studies should investigate alternative imaging modalities, such as rapid-sequence MRI, and structured observation protocols to better determine their practicality and effectiveness. Ultimately, reducing unnecessary CT use requires a multifaceted approach that includes strict adherence to guidelines, structured educational initiatives, active parental involvement, and exploration of safer imaging methods. Such a comprehensive strategy will help ensure optimal care and improved patient safety in pediatric head trauma.}, number={2}, publisher={Harran Üniversitesi}