Cranial CT yield and predictors in children aged 0-36 months with head trauma.

INTRODUCTION: Cranial computed tomography (CT) is frequently used in young children with head trauma, although its diagnostic yield may be limited without specific clinical risk factors. This study evaluated cranial CT findings and clinical predictors of pathological CT findings in children aged 0-36 months presenting to the emergency department with head trauma.

METHODS: This retrospective observational study included 1434 children aged 0-36 months who presented with head trauma and underwent cranial CT between January 1 and December 31, 2022. Clinical variables included scalp hematoma, scalp laceration, vomiting, clinical deterioration during observation, and trauma mechanism. The primary outcome was pathological cranial CT findings. Multivariable logistic regression and receiver operating characteristic analyses were performed.

RESULTS: The median age was 1 year, and falls accounted for 97.8% of injuries. CT findings were normal in 92.2% of patients, while pathological findings were detected in 7.8%. Pathological CT findings were more frequent in symptomatic than asymptomatic patients (18.4% vs. 2.4%; p < 0.001) and in infants younger than 12 months compared with children aged 12 months or older (11.7% vs. 5.6%; p < 0.001). Clinical deterioration (OR: 20.22; 95% CI: 8.86-46.13), scalp hematoma (OR: 11.29; 95% CI: 7.05-18.06), and vomiting (OR: 3.73; 95% CI: 1.87-7.43) were independent predictors of pathological CT findings. The multivariable model showed good discrimination (area under the curve: 0.841; sensitivity: 76.8%; specificity: 83.5%).

CONCLUSION: Cranial CT findings were normal in most imaged children aged 0-36 months with head trauma. Clinical deterioration, scalp hematoma, and vomiting may support more selective neuroimaging decisions.