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Imaging of Pediatric Head Injury in the Emergency Department

Wylie, Matthew C. MD*; Merritt, Chris MD, MPH*; Clark, Melissa PhD, MS; Garro, Aris C. MD, MPH*; Rutman, Maia S. MD

doi: 10.1097/PEC.0000000000000227
Original Articles

Objectives Computed tomography (CT) is the standard for immediate imaging of head-injured children, but it uses radiation that predisposes to malignancy. The study goals were to describe imaging practices in this population and to identify barriers to rapid magnetic resonance imaging (MRI) use.

Methods A cross-sectional survey of physicians who care for pediatric patients in emergency departments was conducted. Survey questions included hospital characteristics, access to imaging technology, use of imaging studies, and use of radiation reduction practices.

Results A total of 459 eligible respondents completed the questionnaire, which represented a response rate of 24.1%. Almost all the respondents (97.7%) reported that radiation concerns influence clinical management of children and adolescents with head trauma. Head CT use was more frequently reported than MRI (55.3% vs 1.5% reported use in more than 10% of patients, respectively). Frequent CT use was associated with practice in community hospitals (P = 0.005), whereas pediatric residency training and pediatric volumes greater than 30,000 visits per year were associated with less frequent use (P = 0.015 and P = 0.028, respectively). In 94.5% of the respondents, reported CT was always available compared with 24.3% reporting MRI as always available (P < 0.001). Reported obstacles to MRI as a screening tool for head-injured children included limited scanner availability (93.5%), patient intolerance of MRI (87.2%), and longer acquisition times (83.3%).

Conclusions Concerns about radiation exposure motivate change of practice in the management of head-injured children and adolescents. Head CT use is greater at hospitals with lower pediatric volumes, community hospitals, and by providers without pediatric residency training. Obstacles to increased use of MRI or head-injured children include availability, patient intolerance, and long scan acquisition times.

Supplemental digital content is available in the text.

From the *Section of Pediatric Emergency Medicine, Department of Emergency Medicine, Hasbro Children’s Hospital/Alpert School of Medicine at Brown University; †Section of Emergency Medicine, Department of Epidemiology, Brown University, Providence, RI; and ‡Department of Pediatrics, Dartmouth-Hitchcock Medical Center, Lebanon, NH.

Disclosure: The authors declare no conflict of interest.

Reprints: Matthew Wylie, MD, Department of Public Health, Brown University, 45 Prospect St, Providence, RI 02912 (e-mail:

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s Web site (

Financial support: Stipend from the University Emergency Medicine Foundation, Providence, RI.

Presented at the Pediatric Academic Societies meeting, May 7, 2013, Washington, DC.

© 2014 Lippincott Williams & Wilkins, Inc.