Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Avoid malpractice while treating minor head trauma in children

Maxwell S. Kennerly
Conditions
February 10, 2012
Share
Tweet
Share

In October 2011, the Centers for Disease Control and Prevention reported a 60% increase in “emergency department visits for sports– and recreation–related traumatic brain injuries, including concussions, among children and adolescents” over the past decade. That’s good news: as the CDC’s press release said, they believe the increase was due in part to “growing awareness among parents and coaches, and the public as a whole, about the need for individuals with a suspected TBI to be seen by a health care professional.” Great improvements have been made in terms of sports head injuries among kids, like through the CDC’s Heads Up initiative.

That’s the good news, but it raises an important question for emergency physicians and primary care physicians: are you ready for all the minor head trauma cases coming your way?

Viewed through a narrow lens, the solution to a suspected brain injury is obvious: if a kid complains about anything relating to their head, give them a CT scan. But CT scans come with their own costs and risks, not least exposing a developing brain to a year’s worth of background radiation.

I’m not here to tell you where the CT / no-CT line should be drawn. I can tell you, however, how I would draw that line as a medical malpractice lawyer when a parent comes in and tells me their doctor didn’t order a CT scan after a minor head trauma and their child later developed serious sequelae.

“Failure to diagnose” is most medical malpractice lawyers’ bread and butter. When we investigate cases, we use our own version of a differential diagnosis, scratching off every way we can lose until the case looks solid. Think jurors don’t understand the incremental risk of CT scans? Consider this sentence: “one head CT scan has more radiation than 20,000 trips through the TSA scanner at the airport.” We trial lawyers know the defense expert will say some version of that in front of the jury. We have to be ready to explain why it’s worth the risk.

Over the past few years there have been several major studies attempting to determine the indications of clinically significant TBI, including the National Emergency X-Radiography Utilization Study II (NEXUS II), and the Pediatric Emergency Care Applied Research Network (PECARN). There wasn’t, however, any clear synthesis of those studies’ findings until now, in “Evaluation of Minor Head Trauma in Pediatric Patients” by Dr. Amira Munas Bass and Dr. N. Ewen Wang, published in the January 2012 issue of Critical Decisions in Emergency Medicine.

Malpractice lawyers tend not to dwell on any particular publications, but we always like to know the latest empirical research before we decide whether or not to take a case, and the clearer the guidance, the better, both in taking strong cases and in rejecting weak ones. We know there’s a lot of medical malpractice out there, but the majority of our potential cases should not be pursued.

Based on the Bass-Wang article, we know that, if a primary care physician doesn’t send a child to the ED, or the ED discharges a child without a CT, after the child showed an abnormal mental status, emesis, evidence of a skull fracture or scalp trauma, or was the victim of a severe mechanism or fall from a great height, and the child develops serious sequelae, both NEXUS II and PECARN indicate the child’s symptoms should have indicated a clinically significant TBI. In contrast, if the only indications of a clinically significant TBI are the presence of a seizure or amnesia, then we similarly know under NEXUS II and PECARN that these symptoms may not have the same predictive value as was once believed.

In short, if you come into contact with pediatric patients who suffer minor head trauma, it may be time to brush up on your decision rules. You might just spare yourself a malpractice suit — not to mention save a life.

Maxwell S. Kennerly is an attorney who blogs at Litigation & Trial.

Submit a guest post and be heard on social media’s leading physician voice.

Prev

When medical advances do the world a disservice

February 10, 2012 Kevin 1
…
Next

Conflicts of interest don't always involve money

February 10, 2012 Kevin 2
…

Tagged as: Emergency Medicine, Malpractice, Pediatrics, Radiology

Post navigation

< Previous Post
When medical advances do the world a disservice
Next Post >
Conflicts of interest don't always involve money

ADVERTISEMENT

More by Maxwell S. Kennerly

  • a desk with keyboard and ipad with the kevinmd logo

    Why you would want a younger doctor in the hospital

    Maxwell S. Kennerly

More in Conditions

  • The truth about sun exposure: What dermatologists want you to know

    Shafat Hassan, MD, PhD, MPH
  • How a South Asian nurse challenged stereotypes in health care

    Viksit Bali, RN
  • Could ECMO change where we die and how our organs are donated?

    Deepak Gupta, MD
  • From Civil War tales to iPhones: a family history in contrast

    Richard A. Lawhern, PhD
  • The hidden dangers of over-the-counter weight-loss supplements

    STRIPED, Harvard T.H. Chan School of Public Health
  • How denial of hypertension endangers lives and what doctors can do

    Dr. Aminat O. Akintola
  • Most Popular

  • Past Week

    • How a doctor defied a hurricane to save a life

      Dharam Persaud-Sharma, MD, PhD | Physician
    • Why primary care needs better dermatology training

      Alex Siauw | Conditions
    • Guilty until proven innocent? My experience with a state medical board.

      Jeffrey Hatef, Jr., MD | Physician
    • Why physician strikes are a form of hospice

      Patrick Hudson, MD | Physician
    • Why medical notes have become billing scripts instead of patient stories

      Sriman Swarup, MD, MBA | Tech
    • Federal shakeup of vaccine policy and the battle for public trust [PODCAST]

      American College of Physicians & The Podcast by KevinMD | Podcast
  • Past 6 Months

    • Why transgender health care needs urgent reform and inclusive practices

      Angela Rodriguez, MD | Conditions
    • COVID-19 was real: a doctor’s frontline account

      Randall S. Fong, MD | Conditions
    • Why primary care doctors are drowning in debt despite saving lives

      John Wei, MD | Physician
    • New student loan caps could shut low-income students out of medicine

      Tom Phan, MD | Physician
    • Confessions of a lipidologist in recovery: the infection we’ve ignored for 40 years

      Larry Kaskel, MD | Conditions
    • mRNA post vaccination syndrome: Is it real?

      Harry Oken, MD | Conditions
  • Recent Posts

    • Federal shakeup of vaccine policy and the battle for public trust [PODCAST]

      American College of Physicians & The Podcast by KevinMD | Podcast
    • Why clinicians must lead health care tech innovation

      Kimberly Smith, RN | Tech
    • The truth about sun exposure: What dermatologists want you to know

      Shafat Hassan, MD, PhD, MPH | Conditions
    • Learning medicine in the age of AI: Why future doctors need digital fluency

      Kelly D. França | Education
    • How a South Asian nurse challenged stereotypes in health care

      Viksit Bali, RN | Conditions
    • Doctors reclaiming their humanity in a broken system [PODCAST]

      The Podcast by KevinMD | Podcast

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 8 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

ADVERTISEMENT

  • Most Popular

  • Past Week

    • How a doctor defied a hurricane to save a life

      Dharam Persaud-Sharma, MD, PhD | Physician
    • Why primary care needs better dermatology training

      Alex Siauw | Conditions
    • Guilty until proven innocent? My experience with a state medical board.

      Jeffrey Hatef, Jr., MD | Physician
    • Why physician strikes are a form of hospice

      Patrick Hudson, MD | Physician
    • Why medical notes have become billing scripts instead of patient stories

      Sriman Swarup, MD, MBA | Tech
    • Federal shakeup of vaccine policy and the battle for public trust [PODCAST]

      American College of Physicians & The Podcast by KevinMD | Podcast
  • Past 6 Months

    • Why transgender health care needs urgent reform and inclusive practices

      Angela Rodriguez, MD | Conditions
    • COVID-19 was real: a doctor’s frontline account

      Randall S. Fong, MD | Conditions
    • Why primary care doctors are drowning in debt despite saving lives

      John Wei, MD | Physician
    • New student loan caps could shut low-income students out of medicine

      Tom Phan, MD | Physician
    • Confessions of a lipidologist in recovery: the infection we’ve ignored for 40 years

      Larry Kaskel, MD | Conditions
    • mRNA post vaccination syndrome: Is it real?

      Harry Oken, MD | Conditions
  • Recent Posts

    • Federal shakeup of vaccine policy and the battle for public trust [PODCAST]

      American College of Physicians & The Podcast by KevinMD | Podcast
    • Why clinicians must lead health care tech innovation

      Kimberly Smith, RN | Tech
    • The truth about sun exposure: What dermatologists want you to know

      Shafat Hassan, MD, PhD, MPH | Conditions
    • Learning medicine in the age of AI: Why future doctors need digital fluency

      Kelly D. França | Education
    • How a South Asian nurse challenged stereotypes in health care

      Viksit Bali, RN | Conditions
    • Doctors reclaiming their humanity in a broken system [PODCAST]

      The Podcast by KevinMD | Podcast

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Avoid malpractice while treating minor head trauma in children
8 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...