Pediatric Providers Management of Concussion Patients: Still Too Many CTs Are Ordered

Monday, October 13, 2014: 11:45 AM
Marriott Hall 6 (San Diego Marriott Marquis )
Wendy J. Pomerantz, MD, MS1, Michael Gittelman, MD2, Michael FitzGerald, PhD1, Courtney L. Schaiper, MS3 and Brad G. Kurowski, MD, MS3, (1)Cincinnati Children's Hospital, Cincinnati, OH, (2)Cincinnati Children's Hospital Medical Center, Cincinnati, OH, (3)Cincinnati Childrens Hospital, Cincinnati, OH


Medical visits for mild traumatic brain injury, or concussion, have more than doubled over the last ten years. Pediatric physicians serve as the initial evaluators for the overwhelming majority of concussed patients. The purpose of this study was to assess pediatric physician’s management of patients who sustain concussions with regard to referrals and ordering head CTs.


A web-based survey was developed with expert input and consisted of respondent demographic information and concussion management questions across 3 scenarios of different aged children all with low risk for intracranial injury, no loss of consciousness, normal physical exams and no indication for CT evaluation. Decisions surrounded pediatric physician referral and CT imaging patterns. Subjects consisted of all primary care physicians affiliated with Cincinnati Children’s Hospital with active e-mail addresses.


86/378 (22.7%) that met inclusion criteria responded. 67.4% were females, 94.2% were pediatricians, and  63.3% evaluated < 10 patients for concussion in the past year. 30.2% had been in practice <10 years, 29.1% 11 - 20 years, and 40.7% > 20 years. Table  1 shows the referral patterns across scenarios. For scenario 1, 11.5% would refer for head CT scan, for scenario 2, 57.2% and for scenario 3, 27.0%.

Table 1

See in office vs. referral

Scenario 1:

14 y/o patient  presents the day of injury with headache, nausea and amnesia


Scenario 2:

9 y/o patient  presents 1 day after injury with headache and nausea


Scenario 3:

16 y/o patient presents 5 days after injury with nausea and dizziness






See in office




Refer to ED




Refer to specialist













Pediatric providers are more likely to refer patients to the Emergency Department and request CTs on patients with concussions after 24 hours of symptoms compared to acute injury. Further education about concussion management and limiting CT scans is necessary.