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Let's presume that a young child suffers isolated blunt trauma to the
head and has a history of ~ 30 seconds of LOC and presents to the ED
with a GCS of 15 and no focal neuro signs + minimal/no ongoing symptoms
eg. headache, nausea, dizziness, amnesia. The first question is whether
a CT scan is necessary? Let's presume that you decide to order a CT scan
to rule-out a neurosurgical problem => when do you actually perform the
CT scan? If you are looking for potential neurosurgical problems
(epidural or subdurals or large intraparenchymal bleeds), should you
delay the CT scan so as to increase the likelihood of a positive CT scan
detection. In other words, if the blunt trauma occurred < 10 minutes
prior to ED arrival => would you deliberately delay the CT scan for a
few hours on the presumption that a small, early intracranial bleed may
not yet be visible on a stat CT scan performed within 30 minutes of the
injury?
 
Jeff.
 
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