ER docs shouldn't be too quick to order CT scans for kids

2013-05-20 09:56:01 by Holly Pupino, Media Relations Specialist, as posted on the inside.akronchildrens.org blog.

A recent study found that ER doctors should observe kids with head injuries longer and wait before using CT scans to help prevent needless radiation exposure. These findings weren’t all that surprising to Dr. Maria Ramundo, a pediatric ER doctor at Akron Children’s Hospital.


I called Dr. Ramundo after reading a story on MSNBC suggesting that a more wait-and-see approach for CT scans is advisable for children coming to the ER following a head injury. CT scans, while a valuable medical tool, expose children to radiation that, over their lifetime, can increase their risk of cancer.

“A lot of what is in this study gets to the benefits of the pediatric emergency department,” said Dr. Ramundo. “My population is 100 percent kids and we rely greatly on our clinical observations. We know child development and how infants, toddlers and older children should look and respond in various situations.”

If a child who has suffered a fall, for example, has a normal neurological exam and is eating, drinking and playing, Dr. Ramundo would send the child home after a period of observation in the ER. She would educate the parents about symptoms that indicate they should bring their child back to the ER immediately.

She would perform a head CT if the child has any of the following symptoms:



  • multiple episodes of vomiting

  • severe headache

  • acting confused

  • seizure

  • loss of consciousness lasting more than one minute

  • amnesia

  • history of a bleeding disorder

  • not acting age appropriate

  • abnormalities on the neurological exam


If the family lacks transportation and it would be difficult to get their child back to the ER, she would observe the child for a few hours at the hospital.

Children who sustain more than a trivial head injury should be examined by their pediatrician or family doctor before returning to activities such as sports or gym class.

“Sometimes parents request a CT,” Dr. Ramundo said. “But most are very responsive when we educate them about the benefits and risks.”

If a CT is necessary, Akron Children’s radiologists and radiology technicians follow strict guidelines to use the lowest dose of radiation possible. In addition, child life specialists are on hand to explain procedures in ways children understand to help them overcome fears.

In this video, Akron Children’s Radiology Chairman Michael Rubin, MD, talks about the techniques and technologies we use to reduce radiation in imaging procedures.

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