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A better way to diagnose and treat children with concussions

It's inevitable that, in the course of growing up, a child should experience a few knocks on the head. Often, parents scurry their children to the doctor's office where they undergo a computed topography (CT) scan to assess the severity of the damage and figure out treatment and next steps.

Most children taken to the hospital after a head injury end up having normal CT scans, which, while potentially indicative of a concussion and mild traumatic brain injury, usually mean that the child does not need constant around-the-clock monitoring and an escalation to more intense care.

But, what if the CT scan is abnormal?

"Little to no consensus, previously"

Typically, with abnormal CT scans, children are at a higher risk of deteriorating in condition, requiring constant monitoring. However, doctors were previously unable to come to an agreement on the type and duration of treatment required.

Now, pediatric neurosurgeons at the Washington University School of Medicine in St. Louis have developed a risk assessment system that should help doctors determine whether children with abnormal CT scans can remain monitored in a general ward at the hospital or if they require the specialization of an intensive care unit (ICU), according to a recent article published by the University and a study published on February 13 in JAMA Pediatrics.

How does it work?

The researchers combed through data of 40,000 children to develop their system, now called the Children's Intracranial Injury Decision Aid score (CHIIDA). CHIIDA is a risk score ranging from 0 to 24, with the higher the score indicating the greater need for more extensive monitoring and even an ICU stay. A score of zero, for example, shows that the child is at very low risk for both short and long term effects.

The score is based on four factors, including patient alertness and responsiveness, which is measured by doctor-patient interaction. The other three scores are based on analysis of the CT scan, which can lead to greater objectivity and scientific consensus.

The hope is that with the widespread adoption of this system, doctors can prioritize care where necessary, and provide the necessary attention to seriously injured children, while avoiding sending others to the ICU unnecessarily.

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