Abstract Details

Title Utilization and Outcomes of Cranial Computed Tomography in a Pediatric Population

Topic Child Neurology/Developmental Neurobiology

Presentation(s) P02 - (-)

Poster/Presentation
Number 097

Objective

Background BACKGROUND: Recent studies have shown an increase in CT scans in children over the past ten years, despite the evidence for risks of radiation exposure.

Design/Methods DESIGN/METHODS: Electronic medical records were reviewed for all head CT scans done at UCSF Medical Center in children ages 0-18 years between January 1, 2006 and September 1, 2012. The reasons for and outcomes of the scans were determined based on review of the radiology reports and medical records. Analysis was performed to stratify CT scans based on reason and outcome.

Results RESULTS: 544 pediatric cranial CT scans were performed in the UCSF emergency department between 2006-2012. The median age was 7.16 years [IQR: 2.38-14.25]. The most common indication for imaging was head trauma (n= 237, 43.57%), followed by suspected ventriculoperitoneal shunt (VPS) malfunction (n =105, 19.30%), seizure (n =78, 14.34%), headache (n= 62, 11.40%), and suspected brain tumor (n =17, 3.12%). Of the CT scans performed, 155 (28.49%) reported intracranial findings. In the case of seizures, headache, and head trauma specifically, the percentage of intracranial findings was 15.38%, 12.90%, and 5.06%, respectively. 75 (13.79%) of the CT scans were followed by MRI. Of the 75 MRIs done, 38 (50.66%) had intracranial findings, of which 14 (36.84%) were missed by CT.

Conclusions CONCLUSIONS: Cranial CT scans performed in children are often normal, and findings infrequently change management in patients presenting with seizures, head trauma, and headache. Therefore, it may be safer to consider observation or MRI as alternatives to cranial CT imaging and its associated radiation risks, especially for certain presentations, such as seizure and headache, for which CT is low yield.

Authors/Disclosures
Marisa Gardner, MD PRESENTER	No disclosure on file
	No disclosure on file
S. A. Josephson, MD, FAAN (UCSF)	Dr. Josephson has received personal compensation in the range of $50,000-$99,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for JAMA Neurology. Dr. Josephson has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for McGraw Hill---Harrison's Principles of Internal Medicine. Dr. Josephson has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for various legal firms. The institution of Dr. Josephson has received research support from NINDS. Dr. Josephson has received publishing royalties from a publication relating to health care. Dr. Josephson has received publishing royalties from a publication relating to health care.
Regina Berkovich, MD, PhD (Regina Berkovich MD PhD Inc)	The institution of Dr. Berkovich has received personal compensation in the range of $50,000-$99,999 for serving as a Consultant for Alexion, Biogen, Genentec, Mallincrodt, Sanofi, Novartis, . Dr. Berkovich has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Biogen, Genentec, Sanofi, Merck . Dr. Berkovich has received personal compensation in the range of $50,000-$99,999 for serving on a Speakers Bureau for Alexion, Biogen, Sanofi, Merck, Mallincrodt . The institution of Dr. Berkovich has received research support from Biogen, Sanofi, Merck.

��ɫ��

��ɫ��