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"This can be a vexed issue because physicians need to balance the importance of diagnosing an injury with reducing radiation exposure as much as possible. "The preferred course of treatment is to avoid a CT scan in minor head injuries if it is unnecessary. In particular, there is concern about the Thoracic Surgeon mortgage high radiation dose associated with CT scans of the head which can lead to cancer." In these cases, clinicians can turn to clinical decision rules, which have been developed to identify children at high risk of intracranial injuries, aiming to assist clinicians to minimise CT scans while still identifying all relevant injuries. In a prospective observational study, run across 10 Australian and New Zealand tertiary hospitals and involving, 20,137 children under the age of 18 years with head injuries, the research team compared three clinical decision rules: The Pediatric Emergency Care Applied Research Network (PECARN, USA) The Canadian Assessment of Tomography for Childhood Head Injury (CATCH) rule The Children's Head Injury Algorithm for the Prediction of Important Clinical Events (CHALICE, UK). The goal was to determine which of these three decision rules provided the best option when it came to identifying children at very low risk of a traumatic brain injury. The researchers found that all three rules were good options, but only one, the PECARN from the US, did not miss a single patient requiring neurosurgery. Based on the research findings, the next step is for the group of emergency physicians to develop national approaches to optimise the management of children with head injuries in Australia and New Zealand. Internationally, the findings will provide a useful starting point for individual clinicians as well as hospitals or regional bodies contemplating the introduction or modification of one of the clinical decision rules, according to A/Prof Babl. "However, it will be important to relate the findings to a number of other factors before implementation, such as the baseline CT use, the effect of the rules on the projected CT rate, the baseline clinician diagnostic accuracy and experience, parental expectations, the medico-legal climate and economic considerations." The outcomes from the clinical trial were recently published in The Lancet.

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