Indications for Cerebral CT in Neurological Emergencies in the Pediatric Emergency Department: Is There an Abuse?

Abstract

The CT scan is a common tool in the management of pediatric emergencies, especially in the diagnosis of intracranial pathologies, since it provides rapid responses allowing vital decisions to be made. However, by giving an easy access to this kind of examination calls for caution. The advantages and disadvantages of the CT scan, particularly in the pediatric population, must be carefully assessed. The polemic about the indication for brain CT and the increase possibility of its prescription motivated this evaluation of professional practices. We conducted a retrospective descriptive study of 205 patients for whom brain CT was indicated for a non-traumatic neurological emergency in the pediatric emergency department of the mother-child hospital of the CHU Mohamed VI of Marrakech, over a period of one year. The aim was to describe the conditions for prescribing brain CT, its indications and their compliance with international recommendations, as well as the CT results found and their implications on management. Our study included 141 patients: 72 boys and 69 girls, with a mean age of 2 years and 3 months (45 days to 15 years) and a sex ratio of 1.04. Seizures were the main cause of consultation (50.4%), followed by headaches (12.8%), motor deficits and consciousness disorders, which represented 11.3% each. Neurological abnormalities were found in 28% of patients (11% hydrocephalus, 6% epilepsy, 4% psychomotor retardation, 3% central nervous system infections, 2% ischemic stroke, 2% intracranial tumors). Indications for brain CT were dominated by seizures in 38%, HTIC syndrome in 19%, disorders of consciousness in 11%, and neurological deficits in 11%. More than half of the brain CT scans (58%) were considered normal. The CT scans showing abnormalities were related to sequelae or non-evolving pre-existing abnormalities in 25.4%, evolving pre-existing abnormalities in 10.2%, newly discovered abnormalities in 64.4%. Brain MRI was performed in 18% of cases. Among the patients with abnormal brain CT scans, 41% had required emergency medical or surgical intervention. These were intracranial compressive processes, stroke and complicated central nervous system infections. In our context, we found that 75% of brain CT scans complied with international recommendations, whereas 25% were prescribed despite of the recommendations. In the light of our study, we assume that the implementation of the guidelines taking into consideration the conditions of each care facility, as well as adapted training for the attending physicians, would help in personalized decision making in pediatric emergencies, and could improve the use of CT among the pediatric population.