J Pediatr Neurol 2018; 16(01): 036
DOI: 10.1055/s-0037-1617437
Reply to Letter to the Editor
Georg Thieme Verlag KG Stuttgart · New York

Can a CT be Omitted in Pediatric Minor Head Trauma?: A Comment

Christoph Arneitz
Department of Pediatric and Adolescent Surgery, Clinical Center Klagenfurt, Klagenfurt, Austria
› Author Affiliations
Further Information

Publication History

31 October 2017

01 December 2017

Publication Date:
29 December 2017 (eFirst)

Can a CT be Omitted in Pediatric Minor Head Trauma?: A Comment

Thank you very much for the critical review of our study. However, we do not think that a computed tomography (CT) scan can be skipped in every patient with minor head trauma. The definition of “pediatric minor head trauma” has been well-defined and based on current literature review and guidelines.[1] An urgent radiological approach can be obligatory in selective cases. In Table 1 of our study, we listed high and intermediate risk groups of traumatic brain injury which require a CT scan. Out of 214 patients, 3 children were diagnosed with a traumatic intracranial injury, one of them requiring a neurosurgical intervention.

We absolutely agree with Andrade et al that there must be “more careful indications for cranial CT scans in children with minor head trauma.”[2] Our indications for cerebral CT scans in children are even more restrictive than one of the best validated clinical decision rules (the Pediatric Emergency Care Applied Research Network [PECARN]).[3] [4]

Possible unknown underlying bleeding disorders are a critical point and should be integrated in clinical decision rules. We agree, that underlying medical disorders must be part of the diagnostic work-up (SAMPLE – patient assessment).[5] Previously known coagulopathies should lead to a high suspicion of intracranial injury and early radiological work-up in symptomatic patients.