The Child With Head Injury
I have had many parents bring their child after a fall, worrying about internal injuries that may not be apparent but which may prove dangerous later on. Cases of people dying after neglecting such injuries abound, and add to the anxiety, especially since the child herself is quite oblivious.
As a clinician dealing with this situation, my dilemma has always been to weigh the benefit derived from relieving the anxiety of the parents versus the risk of subjecting the child to anesthesia or sedation – which is required in many instances – as well as the small cancer risk arising from radiation exposure.
How do you think I should handle parental anxiety on this issue? Read on to know more about this…[sociallocker id=”862″]
I deal with this on a case-by-case basis – depending on the type of injury, the child’s behavior immediately after the injury as well as later and my findings at the time of examination, as well as the result of my initial counselling. A majority of parents are relieved by the doctor’s assurances, as well as the confidence that they could visit the ER at any time should the need arise and that help would be available at a moment’s notice.
Issues After the Brain Scan
Beyond this, if the child undergoes a brain scan, the next issue that crops up is of an incidental finding on a brain scan – this is pretty frequent, and the need for further counselling is nearly universal due to this. Nearly every scan has something to report, and this now creates a new dimension to parental worry.
[caption id="attachment_803" align="alignleft" width="266"]
An arachnoid cyst is among the most common incidental findings on a brain scan, apart from a Giant Cysterna Magna – and a cause of parental concern, only very rarely of significance[/caption]
This has been an issue I have been grappling with all my working life, but what prompted me to write this post was a recent report – the largest observational study, involving 44,000 children seen for a head injury in 25 hospital emergency departments across the United States. Nearly 16,000 had CT scans to evaluate an injury, and about 4 percent of the scans revealed incidental findings ranging from enlarged tonsils to life-threatening cancers. This counts as the largest study on so-called “incidental findings” on CT scan of brains, which is the issue I was talking about earlier.
The Study on Incidental Findings on Brain Scans
The researchers stratified the incidental findings into 3 categories: those requiring immediate evaluation or treatment; those that required only appropriate outpatient follow up; and those that merited further investigation based on current symptoms (the serious category). Only 0.1 percent of the overall sample of CTs fell into the most serious category.
The percentage of children who are actually found to have a serious illness unexpectedly while doing a scan for head injury is so low that it is not justified to do a scan for this reason alone; the recommendation is to continue doing a brain scan on these children only if the situation that brought them to the hospital merits it.
For parents, the message is that even if rarely such things are identified, the thought of such incidentally found abnormalities or disease should not guide us or force us into performing tests – this reflects a mind-set which is “looking for trouble” and which is “going to find it”! [/sociallocker]