Imaging for Children <16 with a Head Injury

Warning

Purpose

To provide guidance on appropriate radiological imaging in children & young people with a head injury.

Scope

All clinicians caring for children & young people aged < 16yrs who present within 72 hours of a head injury.

Definitions

Head injury is any injury to the head.

Roles and Responsibilities

The assessing clinician and radiology staff should determine the need for imaging as indicated in this guideline and should ensure any request complies with IRMER regulations.

Main Content

Most children who present with a head injury will not require any imaging. This guideline provides indications for imaging the small number of children who are at risk of associated brain injury / complications.

Plain x-rays (i.e SXR) is not routinely indicated in children with head injury

CT scanning should be performed if, after discussion with a senior ED clinician (ideally consultant) there is:

  • Suspicion of non-accidental injury
  • Clinical evidence of base of skull fracture
  • Any new focal neurological deficit
  • A reduced conscious level  (aged over 1yr: GCS <14 at presentation, or < 15 after 2 hrs; aged under 1yr GCS <15 at presentation)
  • A suspected open fracture, penetrating brain injury or tense fontanelle
  • A bruise, swelling or laceration of more than 5 cm on the head and the child is aged under 1 year
  • A bleeding disorder or anticoagulation with any neurological symptoms / signs

Children with the following should be discussed with senior ED clinician (ideally consultant), observed for 2- 4 hrs and a CT performed if any deterioration / failure to improve / ongoing concern:

  • Loss of consciousness lasting more than 5 minutes (witnessed).
  • Abnormal drowsiness
  • Persistent vomiting
  • Significant mechanism of injury (e.g high energy RTA, fall >3m)
  • Amnesia (antegrade or retrograde) lasting more than 5 minutes
  • Bleeding disorder or anticoagulation with no neurological concerns (must be discussed with haematology team – may need longer period of observation) 

Any child with an abnormal CT scan, or persisting decreased conscious level or persisting focal neurology should be discussed with the on-call neurosurgical team (via switchboard)

Editorial Information

Last reviewed: 01/09/2021

Next review date: 01/09/2024

Version: 1.0