Because intracranial injury can occur with or without fractures and US does not have a high sensitivity for hemorrhages, it does not currently have a significant role in head trauma imaging and as such is not considered in these variant procedures. Discussion of Procedures by Variant Variant 1: Child. Minor acute blunt head trauma. Very low risk for clinically important brain injury per PECARN criteria. Excluding suspected abusive head trauma. Initial imaging. Radiography Skull Not all skull fractures are evident by radiographs, and up to 50% of intracranial injuries in children occur in the absence of fracture [2,33]. Therefore, radiographs are not sufficient to evaluate for traumatic injury [9]. Head Trauma-Child CTA Head There is no relevant literature or expert consensus supporting the use of CT angiography (CTA) in the initial evaluation of children with minor trauma and very low risk for intracranial injury. MRI Head There is no relevant literature or expert consensus supporting the use of MRI in the initial evaluation of children with minor trauma and very low risk for intracranial injury. MRA Head There is no relevant literature or expert consensus supporting the use of MR angiography (MRA) in the initial evaluation of children with minor trauma and very low risk for intracranial injury. Arteriography Cerebral There is no relevant literature or expert consensus supporting the use of conventional cerebral angiography in the initial evaluation of children with minor trauma and very low risk for intracranial injury. Variant 2: Child. Minor acute blunt head trauma. Intermediate risk for clinically important brain injury per PECARN criteria. Excluding suspected abusive head trauma. Initial imaging. Radiography Skull Not all skull fractures are evident by radiographs, and up to 50% of intracranial injuries in children occur in the absence of fracture [2,33]. Therefore, radiographs are not sufficient to evaluate for traumatic injury [9].
Head Trauma Child PCAs. Because intracranial injury can occur with or without fractures and US does not have a high sensitivity for hemorrhages, it does not currently have a significant role in head trauma imaging and as such is not considered in these variant procedures. Discussion of Procedures by Variant Variant 1: Child. Minor acute blunt head trauma. Very low risk for clinically important brain injury per PECARN criteria. Excluding suspected abusive head trauma. Initial imaging. Radiography Skull Not all skull fractures are evident by radiographs, and up to 50% of intracranial injuries in children occur in the absence of fracture [2,33]. Therefore, radiographs are not sufficient to evaluate for traumatic injury [9]. Head Trauma-Child CTA Head There is no relevant literature or expert consensus supporting the use of CT angiography (CTA) in the initial evaluation of children with minor trauma and very low risk for intracranial injury. MRI Head There is no relevant literature or expert consensus supporting the use of MRI in the initial evaluation of children with minor trauma and very low risk for intracranial injury. MRA Head There is no relevant literature or expert consensus supporting the use of MR angiography (MRA) in the initial evaluation of children with minor trauma and very low risk for intracranial injury. Arteriography Cerebral There is no relevant literature or expert consensus supporting the use of conventional cerebral angiography in the initial evaluation of children with minor trauma and very low risk for intracranial injury. Variant 2: Child. Minor acute blunt head trauma. Intermediate risk for clinically important brain injury per PECARN criteria. Excluding suspected abusive head trauma. Initial imaging. Radiography Skull Not all skull fractures are evident by radiographs, and up to 50% of intracranial injuries in children occur in the absence of fracture [2,33]. Therefore, radiographs are not sufficient to evaluate for traumatic injury [9].