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This article was published 10/7/2018 (1454 days ago), so information in it may no longer be current.
Doctors treating children with head injuries should add one more item to their checklist when considering whether to order a CT (computed tomography) scan or surgical intervention, a new study suggests.
A team of researchers from across Canada — including the head of the University of Manitoba’s pediatrics department — announced an improved method to determine if children with minor head injuries need such measures in a report published on Monday in the Canadian Medical Association Journal.
The new rule adds to the CATCH assessment method, which lists seven things pediatricians should look for: how alert a patient is, open fractures, persistent headaches, irritability during an exam; basal skull fractures, a hematoma (and dangerous bruising), and how dangerous the mechanism of injury was.
"The first CATCH was pretty good, but we needed to add one more area to make sure we really caught all the kids that needed to be scanned with the CT who presented with a minor injury," said Dr. Terry Klassen, medical director at the U of M’s pediatrics department and scientific director for the Children’s Hospital Research Institute of Manitoba.
The result is CATCH2, said Klassen, who has been researching head-trauma treatment for more than 20 years.
"(The study) found we needed to add in ‘greater or equal to four episodes of vomiting,’" he said.
"That’s not just sometimes, when you get a bump on the head and you throw up once. It’s repeated vomiting that seems to be, in CATCH2, a sign for something that potentially needs more intervention."
Funded by the Canadian Institutes for Health Research, the study examined more than 4,000 children, varying from newborns to 16-year-olds, who visited emergency departments with head injuries. Physicians were trained to use the CATCH2 rule to assess whether the patient would need a CT scan.
The CATCH2 rule was "highly sensitive" for identifying patients who required surgical intervention and those with brain injuries on CT scans, the paper reads.
Klassen said the new rule looks to standardize treatment in doctor’s offices across the country for next steps, such as a craniotomy, intubation or ventilation in minor injury cases.
It also eliminates the cost and potential harm of an unnecessary CT scan, he said, adding evidence suggests repeated head CT scans predispose the body to increased radiation risks and can cause harm to the brain’s development.
"If we restrict the CT scan to those that truly need it, as defined by this criteria, I think you’re doing it then on the kids for which there’s strong scientific research and evidence to use it in that clinical context."
The next step is sharing the research with Winnipeg-based health education body Translating Emergency Knowledge for Kids (TREKK), Klassen said.
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Maggie Macintosh reports on education for the Winnipeg Free Press. Funding for the Free Press education reporter comes from the Government of Canada through the Local Journalism Initiative.