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ISOLATED VOMITING–A POOR INDICATION FOR CT SCAN IN HEAD INJURY?
  1. J Fryer,
  2. S Pusapati,
  3. E Abrahamson
  1. Paediatric Emergency Department, Chelsea and Westminster Hospital, London, United Kingdom

Abstract

Objectives & Background Minor head injuries account for a significant number of paediatric presentations to the Emergency Department. In 2007 NICE produced national guidelines to improve and standardise practice across the UK. One indication for CT head scanning is vomiting ≥3 times, even in the absence of any other risk factors. In this study we reviewed CT outcomes with specific focus on children with isolated vomiting.

Methods All CT Heads performed by Chelsea and Westminster Hospital Paediatric ED for minor head injury in patients under 16 years of age between July 2007 and May 2013 were reviewed. We identified those in whom the sole indication for CT head was vomiting ≥3 times post head injury.

Results 8096 children attended our department with head injury during the study period. Of these 516 (6.4%) underwent CT of the head. In 104 patients (20.2%) the indication for the CT was isolated vomiting, as the sole indication. Of this group, only one child had an abnormal CT (a minor finding requiring no intervention). The remaining 412 patients in the study had other NICE indications for a CT (sometimes multiple). Of these 67 (16.3%) had an abnormal scan.

Conclusion This study looks at practice in our unit over a 6 year period, starting 6 months after the 2007 NICE guidelines were introduced. This clearly shows that a large percentage of CTs are being performed on children following minor head injury on the basis of vomiting alone (20.2%). The yield of this is however extremely low with only 0.96% of the patients scanned having an abnormality. There are other clinical decision making algorithms in use internationally which do not have isolated vomiting as an indicator. We believe the current NICE guideline is exposing children‘s' heads to unnecessary ionising radiation.

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