American Association of Neurological Surgeons and Congress of Neurological Surgeons

Don’t routinely obtain CT scanning of children with mild head injuries.

A mild traumatic brain injury is a temporary loss of neurologic function resulting from a blunt blow to the head or an acceleration/deceleration injury. There are predictors that a more severe injury has occurred and CT scanning may be appropriate. In patients younger than age two, a persistent altered mental status, non-frontal scalp hematoma, loss of consciousness for five seconds or more, severe injury mechanism, palpable skull fracture or not acting normally according to the parent may be signs of a more serious injury. In patients older than two, prolonged abnormal mental status, any loss of consciousness, history of vomiting, severe injury mechanism, clinical signs of basilar skull fracture or severe headache may also necessitate CT imaging. Any patient with a traumatic injury to the head that has any neurologic deficits should also be imaged if no other cause can be determined.

These items are provided solely for information and educational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items on this list or their individual situation should consult their physician. This Choosing Wisely® document does not represent a “standard of care,” nor is it intended as a fixed treatment protocol. It is anticipated that there will be patients who will require less or more treatment than the average. It is also acknowledged that in atypical cases, treatment falling outside this recommendation list will sometimes be necessary. This document should not be seen as prescribing the type, frequency or duration of intervention. Treatment should be based on the individual patient’s need and physician’s professional judgment. This document is designed to function as a guide and should not be used as the sole reason for denial of treatment and services. This document is not intended to expand or restrict a health care provider’s scope of practice or to supersede applicable ethical standards or provisions of law, but to encourage discussion of these issues between physician and patient, encourage active patient participation in health care decision-making, and foster greater mutual understanding.