Head trauma remains one of the leading causes of morbidity and mortality in the pediatric population globally, contributing significantly to emergency department visits and hospital admissions. The unique anatomical and physiological characteristics of children, including a relatively larger head-to-body ratio, thinner cranial bones, and immature motor coordination, predispose them to a higher risk of head injuries compared to adults  [1]. These injuries can vary widely in clinical presentation, ranging from minor scalp abrasions to severe intracranial hemorrhages, often posing diagnostic challenges in younger patients due to nonspecific symptoms and limited communication abilities  [2].

Timely and accurate identification of significant intracranial pathology is crucial to prevent long-term neurological sequelae. Computed Tomography (CT) of the head remains the gold standard imaging modality in acute care settings, offering rapid assessment and high diagnostic sensitivity for detecting intracranial injuries  [3]. However, the potential long-term risks associated with ionizing radiation, particularly in the developing brains of children, have raised concerns about the indiscriminate use of CT scans. Excessive exposure can increase lifetime cancer risk, prompting a need for judicious imaging practices  [4].

To optimize imaging decisions, several clinical decision rules, such as those developed by the Pediatric Emergency Care Applied Research Network (PECARN), have been established to guide CT utilization in children with head trauma. These frameworks aim to balance the need for diagnostic accuracy with minimizing unnecessary radiation exposure [3]. Despite the availability of such guidelines, significant variability persists in CT usage patterns across different healthcare systems and emergency departments, indicating a need for continuous evaluation and adherence to evidence-based practices [5].

This study aims to evaluate the CT imaging characteristics of pediatric head trauma cases presenting in an emergency department, analyze common patterns of injury, and assess the association between Glasgow Coma Scale (GCS) scores and CT findings to aid in clinical decision-making and optimize patient outcomes.

Study Design:

This was a hospital-based observational study conducted to evaluate the computed tomography (CT) imaging characteristics in pediatric head trauma cases presenting to the emergency department.

Study Setting:

The study was carried out in the Department of Radiology and Emergency Medicine at Government Medical College, Vizianagaram, Andhra Pradesh, India.

Study Period:

The data collection was conducted over a period of four months, from March 2024 to June 2024.

Study Population:

The study included pediatric patients aged 1 to 15 years presenting with a history of head trauma to the emergency department during the study period.

Sample Size:

A total of 50 pediatric patients who met the inclusion criteria were enrolled in the study.

Inclusion Criteria:

Pediatric patients aged 1-15 years.

Patients presenting with head trauma (regardless of mechanism).

Patients who underwent non-contrast CT (NCCT) head imaging based on clinical judgment.

Exclusion Criteria:

Patients with pre-existing neurological disorders.

Patients with incomplete clinical or imaging data.

Cases referred from other hospitals with prior imaging.

Data Collection:

Clinical data including demographics (age, gender), mechanism of injury, clinical presentation (e.g., loss of consciousness, vomiting, seizures, scalp injuries), and Glasgow Coma Scale (GCS) scores at admission were recorded using a structured proforma. All patients underwent non-contrast CT head scans, which were interpreted by experienced radiologists.

Outcome Measures:

Primary Outcome: CT imaging findings (normal or abnormal), types of intracranial injuries (e.g., skull fractures, hematomas, contusions).

Secondary Outcome: Association between GCS score and abnormal CT findings.

Statistical Analysis:

Descriptive statistics were used to summarize the demographic, clinical, and imaging data. Frequencies and percentages were calculated for categorical variables (e.g., gender, injury mechanisms), and mean ± standard deviation (SD) was computed for continuous variables (e.g., age). The association between GCS scores and CT findings was analyzed descriptively.

Ethical Considerations:

Required permissions were obtained before starting the study. Informed consent was obtained from the parents or guardians of all participants before enrollment.

A total of 50 pediatric patients presenting with head trauma were enrolled in the study. The mean age of participants was 7.8 ± 3.4 years, with ages ranging from 1 to 15 years. The majority of patients were male (62%), while females constituted 38% (Table 1).

Table 1: Demographic Distribution of Study Participants (n=50)

Mechanism of Injury

The most common mechanism of injury was falls, accounting for 52% of cases, followed by road traffic accidents (28%), sports-related injuries (12%), and assault/abuse (6%). Other mechanisms contributed to 2% of cases (Table 2).

Table 2: Mechanism of Injury

Clinical Presentation

At presentation, loss of consciousness was observed in 38% of patients, vomiting occurred in 30%, and seizures were noted in 6%. Scalp lacerations or contusions were present in 44% of cases. Based on the Glasgow Coma Scale (GCS) at admission, 80% of patients had mild head injury (GCS 13-15), 12% had moderate injury (GCS 9-12), and 8% presented with severe injury (GCS ≤8) (Table 3).

Table 3: Clinical Presentation at Admission

CT Imaging Findings

Out of the total sample, 58% of patients demonstrated normal CT scans, while 42% had abnormal findings. The most common abnormality was skull fractures (18%), followed by subdural hematoma (10%), epidural hematoma (6%), cerebral contusions (4%), diffuse cerebral edema (2%), and intracerebral hemorrhage (2%) (Table 4).

Table 4: CT Imaging Findings

Association Between GCS and CT Findings

A clear association was observed between GCS score and the likelihood of abnormal CT findings. Among patients with mild head injury (GCS 13-15), 30% had abnormal CT results. This proportion significantly increased to 83.3% in the moderate injury group (GCS 9-12) and reached 100% in patients with severe injury (GCS ≤8) (Table 5).

Table 5: Association of GCS Score with Abnormal CT Findings

Outcomes

A total of 5 patients (10%) required neurosurgical intervention, such as hematoma evacuation or decompressive craniectomy. The overall mortality rate in the study cohort was 2% (Table 6).

Table 6: Outcomes

This observational study evaluated the computed tomography (CT) imaging characteristics in pediatric head trauma cases presenting to the emergency department at Government Medical College, Vizianagaram. The findings underscore the pivotal role of CT imaging in diagnosing intracranial injuries and highlight the association between clinical presentation, Glasgow Coma Scale (GCS) scores, and imaging abnormalities.

The study observed a male predominance (62%), consistent with previous research showing higher susceptibility among boys due to increased outdoor activities and risk-taking behaviors (6). The mean age of participants was 7.8 ± 3.4 years, aligning with epidemiological patterns suggesting school-aged children are at greater risk for head trauma (6).

Injury mechanisms were dominated by falls (52%), followed by road traffic accidents (28%), mirroring global and national trends where falls remain the leading cause of pediatric head trauma, particularly among younger children (8). These findings emphasize the need for preventive strategies, such as childproofing homes and promoting road safety initiatives.

CT imaging revealed that 42% of patients had abnormal findings, with skull fractures (18%), subdural hematomas (10%), and epidural hematomas (6%) being the most commonly observed intracranial injuries. These results are consistent with previous studies, which report that skull fractures often accompany significant intracranial pathology (9). However, the relatively high proportion of normal CT scans (58%) reinforces the importance of selective imaging, especially in cases of mild head trauma, to minimize unnecessary radiation exposure (10).

A notable finding was the strong association between GCS scores and abnormal CT findings. Among patients with mild head injuries (GCS 13–15), 30% exhibited abnormal CT findings, compared to 83.3% in the moderate injury group (GCS 9–12) and 100% in the severe injury group (GCS ≤8). This correlation is consistent with prior research, which consistently shows that lower GCS scores are predictive of significant intracranial injuries (7,8).

The neurosurgical intervention rate in this study was 10%, aligning with findings from earlier studies reporting that 5–15% of pediatric head trauma cases require surgical management (9). The mortality rate was 2%, relatively low, likely reflecting the benefits of early diagnosis and prompt management, although it underscores the severe consequences associated with traumatic brain injuries.

This study further reinforces the value of clinical decision rules such as the Pediatric Emergency Care Applied Research Network (PECARN) criteria in guiding imaging decisions for children with minor head trauma. The PECARN rule has been validated as an effective tool to minimize unnecessary CT imaging while maintaining diagnostic safety (11,12). Implementing such protocols could help balance the need for accurate diagnosis with the imperative to limit radiation exposure in pediatric populations.

Limitations of this study include its single-center design and limited sample size (n=50), which may impact the generalizability of the results. Additionally, the study focused only on the acute phase of management and did not assess long-term neurological outcomes, an area that warrants future research.

This study highlights the critical role of CT imaging in the evaluation of pediatric head trauma, particularly in cases with moderate to severe injuries. A strong association was observed between lower GCS scores and a higher incidence of CT-detected intracranial abnormalities. Although 58% of cases showed normal CT findings, the results emphasize the importance of selective imaging guided by clinical assessment to reduce unnecessary radiation exposure. The predominance of falls as the leading mechanism of injury underscores the need for targeted preventive strategies in the pediatric population. Early recognition and timely management of intracranial injuries are crucial for improving clinical outcomes. Future larger, multicenter studies are recommended to further refine imaging protocols and enhance evidence-based pediatric trauma care.

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