Should a CT (Computed Tomography) scan be performed on an 11-year-old male patient who was struck in the head during a football game, experienced transient visual disturbance, but had no loss of consciousness (LOC)?

CT Scan for 11-Year-Old with Head Trauma and Transient Visual Disturbance

A CT scan is indicated for this 11-year-old male patient who experienced a head strike during football with transient visual disturbance, even without loss of consciousness, as this presentation meets intermediate risk criteria for clinically important traumatic brain injury. 1

Risk Assessment Based on PECARN Criteria

For children ≥2 years of age with minor head trauma, risk stratification should follow the Pediatric Emergency Care Applied Research Network (PECARN) criteria:

• High-risk factors (CT strongly recommended):

  • GCS of 14 or other altered mental status
  • Signs of basilar skull fracture 1

• Intermediate-risk factors (CT should be considered):

  • History of loss of consciousness
  • Vomiting
  • Severe mechanism of injury
  • Severe headache
  • Neurological symptoms (including visual disturbance) 1

• Very low-risk (CT can be safely avoided):

  • GCS of 15
  • Normal mental status
  • No clinical signs of basilar skull fracture
  • No loss of consciousness
  • No vomiting
  • No severe injury mechanism
  • No severe headache 1

Analysis of This Case

This patient falls into the intermediate-risk category due to:

• Transient visual disturbance (neurological symptom)
• Mechanism of injury (struck in head during football) 1

Rationale for CT Recommendation

• The risk of clinically important traumatic brain injury in intermediate-risk patients is approximately 0.8% 1
• CT has the advantage of rapid acquisition and excellent sensitivity for acute intracranial hemorrhage and fractures 1
• Transient visual disturbance represents a focal neurologic deficit, which is specifically mentioned in clinical decision rules as an indication for CT 1

Important Considerations

• CT remains the imaging modality of choice in the acute setting for pediatric head trauma 1
• MRI, while more sensitive for certain injuries, is impractical in the emergency setting due to longer examination times, need for safety screening, and potential requirement for sedation in younger children 1
• Skull radiographs are insufficient for evaluation of traumatic brain injury, as up to 50% of intracranial injuries occur without fracture 1

Common Pitfalls to Avoid

• Don't dismiss neurological symptoms: Transient visual disturbance is a significant finding that warrants imaging, even in the absence of loss of consciousness 1, 2
• Don't rely solely on GCS: A normal GCS score does not exclude significant intracranial injury 3
• Don't overemphasize loss of consciousness: LOC is not required for significant brain injury; studies show patients without LOC can still have clinically important findings 3, 2

In summary, while most pediatric head trauma patients do not require imaging, this patient's presentation with transient visual disturbance after a football head strike places him in an intermediate-risk category where CT imaging is appropriate to rule out clinically significant intracranial injury.