Ryan Maura E, Pruthi Sumit, Desai Nilesh K, Falcone Richard A, Glenn Orit A, Joseph Madeline M, Maheshwari Mohit, Marin Jennifer R, Mazzola Catherine, Milla Sarah S, Mirsky David M, Myseros John S, Niogi Sumit N, Partap Sonia, Radhakrishnan Rupa, Robertson Richard L, Soares Bruno P, Udayasankar Unni K, Whitehead Matthew T, Wright Jason N, Karmazyn Boaz
Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.
Panel Chair, Vanderbilt Children's Hospital, Nashville, Tennessee.
J Am Coll Radiol. 2020 May;17(5S):S125-S137. doi: 10.1016/j.jacr.2020.01.026.
Head trauma is a frequent indication for cranial imaging in children. The majority of accidental pediatric head trauma is minor and sustained without intracranial injury. Well-validated pediatric-specific clinical decision guidelines should be used to identify very low-risk children who can safely forgo imaging. In those who require acute imaging, CT is considered the first-line imaging modality for suspected intracranial injury because of the short duration of the examination and its high sensitivity for acute hemorrhage. MRI can accurately detect traumatic complications, but often necessitates sedation in children, owing to the examination length and motion sensitivity, which limits rapid assessment. There is a paucity of literature regarding vascular injuries in pediatric blunt head trauma and imaging is typically guided by clinical suspicion. Advanced imaging techniques have the potential to identify changes that are not seen by standard imaging, but data are currently insufficient to support routine clinical use. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
头部外伤是儿童进行颅脑成像的常见指征。大多数儿童意外头部外伤较轻，且未伴有颅内损伤。应使用经过充分验证的针对儿童的临床决策指南，以识别那些可以安全地不进行成像检查的低风险儿童。对于那些需要进行紧急成像检查的儿童，由于检查时间短且对急性出血具有高敏感性，CT被认为是疑似颅内损伤的一线成像方式。MRI能够准确检测创伤并发症，但由于检查时间长和运动敏感性高，通常需要对儿童进行镇静，这限制了快速评估。关于儿童钝性头部外伤中血管损伤的文献较少，成像通常由临床怀疑来指导。先进的成像技术有可能识别标准成像无法发现的变化，但目前的数据不足以支持其常规临床应用。美国放射学会适宜性标准是针对特定临床情况的循证指南，每年由多学科专家小组进行审查。指南的制定和修订包括对同行评审期刊上的当前医学文献进行广泛分析，并应用成熟的方法（兰德/加州大学洛杉矶分校适宜性方法以及推荐分级评估、制定和评价或GRADE）来评估特定临床场景下成像和治疗程序的适宜性。在缺乏证据或证据不明确的情况下，专家意见可能会补充现有证据，以推荐成像或治疗方法。
