With increasing concerns about concussions, are pediatricians ordering too many CT scans? Some local researchers think the answer may be yes.
Cincinnati Children's emergency medicine physician Dr. Wendy Pomerantz and her team surveyed how pediatricians would treat various brain injury situations. She used three scenarios.
- A 14-year-old patient who sees a doctor the day of injury with headache, nausea and amnesia.
- A 9-year-old patient who sees a doctor the day after injury with headache and nausea.
- A 16-year-old patient who sees a doctor five days after injury with nausea and dizziness.
All the patients exhibited some concussion symptoms but did not lose consciousness, had normal physical exams, and were low risk for bleeding from the brain.
Despite that, many doctors still ordered CT scans. In one scenario 40 percent of doctors ordered a scan even though the odds of finding bleeding or a treatable situation were extremely unlikely.
The researchers found:
- 14 percent were referred to the emergency department in the first scenario.
- 40 percent were referred in the second scenario.
- 27 percent were referred in the third scenario.
"Most of the pediatricians we surveyed - 67 percent - said they see less than 10 patients per year concussions, so I think it's more of a comfort thing," says Pomerantz.
But that comfort comes with risks. CT scans pose increased risk of radiation exposure and children's organs are more sensitive to that than adults.
Plus they're expensive.
Pomerantz says the next step is to talk with doctors about what kinds of materials or information they need to make better diagnoses.
She's presenting her findings Monday at the American Academy of Pediatrics' annual meeting in San Diego.