CT does double duty for infants with head trauma likely caused by abuse

Clinicians treating young children for head trauma due to evident non-accidental injury can wisely and safely reduce radiation dose by ordering CT alone to check for both skull fractures and intracranial damage, according to a study published online Oct. 15 in Pediatric Radiology.

The more common approach is to x-ray the skull and CT the brain, the study authors note in introducing their findings.  

Their aim was to compare the sensitivity of, specifically, skull CT augmented by 3D reconstruction with that of standard radiography as normally used for imaging infants’ skulls in these scenarios.  

Paige Culotta, MD, and colleagues at Baylor College of Medicine and Texas Children’s Hospital retrospectively analyzed the cases of 177 infants (47 percent female, mean/median age of 5 months) who were evaluated for abusive head trauma via both skull radiographs and CT with 3D reconstruction.

Using skull radiography as their reference standard, the team had all exams read by pediatric radiologists and neuroradiologists. Ten percent were additionally read by a second radiologist to check interobserver reliability.

Some 62 patients (35 percent) had skull fractures on radiography, and the CT with 3D reconstruction mirrored these with 97 percent sensitivity and 94 percent specificity.

Culotta and colleagues found no significant difference between plain radiographs and 3D CT scan findings (P-value = 0.18).

“CT with 3D reconstruction is equivalent to skull radiographs in identifying skull fractures,” the authors write. “When a head CT is indicated, skull radiographs add little diagnostic value.”

Or, as they put it in their hypothesis heading into the analysis:

“Using CT as the primary modality to evaluate both fracture and intracranial injury” in children with suspected abusive head trauma “can reduce exposure to radiation without sacrificing performance.”