Ghizoni Ghizoni Ghizoni Ghizoni Ghizoni Indications for head computed tomography in children with mild traumatic brain injury 515 Rev. Col. Bras. Cir. 2013; 40(6): 515-519 TBE-CITE TBE-CITE TBE-CITE TBE-CITE TBE-CITE Indications for head computed tomography in children with mild Indications for head computed tomography in children with mild Indications for head computed tomography in children with mild Indications for head computed tomography in children with mild Indications for head computed tomography in children with mild traumatic brain injury traumatic brain injury traumatic brain injury traumatic brain injury traumatic brain injury Indicações de tomografia de crânio em crianças com trauma cranioencefálico Indicações de tomografia de crânio em crianças com trauma cranioencefálico Indicações de tomografia de crânio em crianças com trauma cranioencefálico Indicações de tomografia de crânio em crianças com trauma cranioencefálico Indicações de tomografia de crânio em crianças com trauma cranioencefálico leve leve leve leve leve ENRICO GHIZONI 1 ; ANDREA DE MELO ALEXANDRE FRAGA 2 ; EMILIO CARLOS ELIAS BARACAT 3 ; ANDREI FERNANDES JOAQUIM 1 ; GUSTAVO PEREIRA FRAGA 4 , TCBC-SP; SANDRO RIZOLI 5 ; BARTO NASCIMENTO 6 A B S T R A C T A B S T R A C T A B S T R A C T A B S T R A C T A B S T R A C T The “Evidence Based Telemedicine - Trauma and Emergency Surgery” (TBE-CITE) performed a critical appraisal of the literature and selected the three most relevant and recent publications on the indications for head computed tomography (CT) scan in pediatric patients with mild traumatic brain injury (TBI). The first study identified patients with mild TBI, high and low risk factors for intracranial injuries detected on CT scan and the need for neurosurgical intervention. The second evaluated the guidelines of the National Institute of Clinical Excellence for pediatric patients with TBI. The outcome of this study was either performing a head CT scan or hospital admission. The last study identified and analyzed the patients in whom the CT scan is not necessary and consequently should not be routinely indicated. Based on the critical appraisal of the literature and expert discussion, the opinion of the TBE-CITE was to favor the adoption of the PECARN guidelines, proposing CT scans for children with GCS of 14, altered level of consciousness and palpable skull fracture, or when warranted by the physician experience, multiple findings or worsening symptoms. Key words: Key words: Key words: Key words: Key words: Craniocerebral trauma. Tomography. Skull. Neurosurgery. Child. EBT-TACS Meeting on Dec 10 th , 2013, with the participation of the following services: St. Michael’ Hospital e Sunnybrook Health Science Center, University of Toronto, Toronto, Canada; Department of Pediatrics, Division of Trauma Surgery, and Division of Neurosurgery, School of Medical Sciences, University of Campinas, Campinas, SP, Brazil. 1. Assistant Physician, Division of Neurosurgery, Department of Neurology, School of Medical Sciences, University of Campinas, Campinas, SP, Brazil; 2. Assistant Physician, Department of Pediatrics, School of Medical Sciences, University of Campinas, Campinas, SP, Brazil; 3. Associated Professor, Department of Pediatrics, School of Medical Sciences, University of Campinas, Campinas, SP, Brazil; 4. TCBC-SP, FACS. Coordinating Professor, Division of Trauma Surgery, Department of Surgery, School of Medical Sciences, University of Campinas, Campinas, SP, Brazil; 5. FRCSC, FACS. Full Professor, Department of Surgery and Critical Care Medicine, University of Toronto; Director, Trauma, St Michael’s Hospital, Toronto, Canada; 6. Assistant Professor, Surgery, Department of Surgery, University of Toronto, Toronto, Canada. INTRODUCTION INTRODUCTION INTRODUCTION INTRODUCTION INTRODUCTION T raumatic brain injury (TBI) is one of the most common indications for hospitalization among children, and is often associated with important morbidity and mortality 1 . In the United States, approximately 150-180 children per 100,000 people are hospitalized annually. Seventy- four to 80% of these children are classified as having mild TBI according to the Glasgow Coma Scale (GCS) scores, of 13-15 2 . The majority of children sustaining mild TBI are discharged home after a brief period of observation in emergency departments. However, a small proportion (0.5%) of these pediatric patients might progress to neurological deterioration, requiring neurosurgical interventions 3,4 . Timely detection and evacuation of intracranial hematomas are fundamen- tal for favorable neurological outcomes in this population. Computed tomography (CT) is the diagnostic method of choice for early detection of traumatic intracranial hematomas 4 . The liberal use of head CT for mild TBI may unnecessarily expose children to ionizing radiation, which in turn may increase the risk of developing leukemia and brain tumors by up to three-fold. In addition, the widespread use of head CT in mild TBI further increases health care costs 5,6 . Although guidelines for the use of head CT for adult patients with mild TBI are available, the indications for head CT in pediatric trauma patients remain controversial due to the limited evidence available to guide its use 7,8 . Due to the high prevalence of TBI in children and consequent widespread use of head CT, development of guidelines for its rational use is urgent. The participants of the Evidence-based Telemedicine – Trauma and Acute Care Surgery (EBT- TACS) journal club conducted a literature review, and herein critically appraise the three most relevant multicenter studies