A large, national multi-center study of thousands of children taken to EDs with minor blunt head trauma has found that most of those with normal computed tomography scans do not require hospitalization for further observation.

Of the more than 13,500 children included in the study, less than 1% had subsequent abnormal CT scans or MRIs and none required neurosurgical intervention.

“We now have definitive evidence supporting discharging most neurologically normal children with head trauma after negative CT scans,” James Homes, professor of emergency medicine in the UC Davis School of Medicine and the study’s lead author and co-investigator, said in a news release.

“Sending these patients home with their parents not only provides good, safe care but it also saves costs. It is a win for everyone concerned.”

While blunt head trauma is the leading cause of death in children older than 1 year, the authors said the finding shows that children with minor blunt head trauma with normal CT scans are at very low risk for subsequent traumatic findings on neuroimaging. More importantly, they are at extremely low risk of needing neurosurgical intervention.

Nevertheless, children fitting this profile frequently are admitted to hospitals for additional observation following normal CT scans. The study authors concluded that “hospitalization of children with minor head trauma after normal CT scan results for neurologic observation is generally unnecessary.”

Children often are admitted to the hospital for additional observation after blunt head trauma to allow frequent neurologic examinations. However, studies in adults have found that neurological problems are rare following minor blunt head trauma and that hospitalization after a normal cranial CT scan is unnecessary.

The study included 13,543 children ages 18 and younger with minor blunt head trauma who were treated in 25 EDs across the United States from June 2004 to September 2006. The patients’ median age was about 9, and 63% were boys. The study included both children with “isolated head trauma” and head trauma with other injuries.

For the study, the authors obtained initial CT results for each patient. Study participants were considered to have normal CT scans if their radiological scans did not reveal intracranial hemorrhage, cerebral concussion, cerebral edema or skull fractures.

Those who were discharged from the ED received follow-up telephone calls at least one week after their ED visit to determine whether the child received additional CT or MRI scans. Families also were asked about neurologic complications, including neurosurgical interventions. Nearly 80% of the study participants were reached for follow-up either by telephone or mail. Those who were hospitalized were followed during their hospitalization for any deterioration.

Hundreds of the patients who were either hospitalized or discharged were found to have received repeated neuroimaging — either CT scans or MRIs or both — but none of the patients required neurosurgical intervention, indicating a very low risk for patients to deteriorate after an initially normal cranial CT scan.

The authors said that the children involved in the study may have required hospitalization for injuries that were not confined to the head, and some also may have been vomiting and thus admitted for intravenous fluid administration. But of the patients hospitalized, more than half only had blunt head trauma and no other injuries or ailments, and most were likely hospitalized simply for neurologic observation.

The study was conducted under the auspices of the Pediatric Emergency Care Applied Research Network and was published June 17 on the website of the Annals of Emergency Medicine. Read the data at http://www.annemergmed.com/article/S0196-0644%2811%2900356-8/abstract.