So of course the tricky question is, what are we looking for?

Do we really want to  find non-operable blood in the brain or  are we creating more morbidity and multiple cat scannings  when we find it?
Does it prevent morbidity as opposed to following clinically for neurological changes? If it were a rural setting and blood was found in an asymptomatic patient, should that child be flown to a pediatric trauma center? What is the number of cT scans performed  to find blood in the head v. finding a lesion that requires clinical interventiuon that we have not suspected clinically?

Just asking 

George L. Foltin, MD, FAAP, FACEP
Director Center For Pediatric Emergency Medicine
212 562-3161
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From: Pediatric Emergency Medicine Discussion List [[log in to unmask]] On Behalf Of Doc Holiday [[log in to unmask]]
Sent: Monday, August 24, 2009 1:05 PM
To: [log in to unmask]
Subject: Re: head trauma in a 7 months baby

From: [log in to unmask]
> would you head CT him because "he is on aspirin"

--> No.

But I will CT him because he's got a significant mechanism (for his age) and no "useful" skull to protect the grey stuff and evidence that the mechanism HAS resulted in significant force-transfer and blood vessel damage (hence the haematoma).

See more than one case a year like this here WITH positive CT findings despite the ONLY clinical finding being a haematoma. Have seen positive CT even without a haematoma and nothing else either - a just-under-one-year-old (can't recall exactly), lifted by 6yr old sister onto her shoulder and "went over", diving forehead first into hardwood floor. No external lesion. Normal on exam. No loss of consciousness. Had a bleed on CT - I can't recall which bleed it was but was NOT operated on eventually (as far as I know and recall)...

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