Wednesday, June 6, 2012

To scan or not to scan - my thoughts

If you recall from my previous post we were considering when to get a head CT on a pediatric patient with a closed head injury, and specifically how to approach this with the family. In general I find that its best to be honest and discuss the criteria outlined in the Kuppermann article. Even if there is a parental expectation of a getting a head CT even before you enter the room, I've found that most parents understand where your coming form when you approach things in a straightforward and honest manner. They just want what's best for their kid - scan or not after all.

But what about those parents that still demand a scan for their child who is making shadow puppets with the otoscope light? First, it's important to address their concerns honestly and without pretension. Find out what they are worried about. Perhaps they had a family member who died in a car crash. Or just had an experience where "the doctors missed something." It's also important to remember that we aren't perfect diagnostic machines. Parents do know their children best. And on the flip side, if a situation seems fishy, especially in cases of suspected non accidental trauma, go ahead and get the scan.

The bottom line is that you should be familiar with how to explain the current evidence to your patients, and to openly acknowledge the risks, benefits, and parental concerns. Even with zero of the predictors for clinically important traumatic brain injury, there is still a 0.5% chance that the kid has a head bleed - even if they look perfect. Every parent - including this one - views their kid as one in a million.