Pediatric Traumatic Brain Injury and Radiation Risks: A Clinical Decision Analysis

Objective To determine the optimal imaging strategy for young children with minor head injury considering health-related quality of life and radiation risk. In children with minor head trauma, the risk of missing a clinically important traumatic brain injury (ciTBI) must be weighed against the risk of radiation-induced malignancy from computed tomography (CT) to assess impact on public health. Study design We included children 24 hours with probabilities from a prospective study of 10 000 children. Sensitivity analysis determined the optimal management strategy over a range of ciTBI risk. Results The no-CT strategy resulted in less risk with the expected probability of a ciTBI of 0.9%. Sensitivity analysis for the probability of ciTBI identified 4.8% as the threshold above which CT all becomes the preferred strategy and shows that the threshold decreases with less radiation. The CT all strategy represents the preferred approach for children identified as high-risk. Conclusion Among children