A research team has developed an adapted algorithm to help clinicians determine the need for computed tomography (CT) in pediatric patients with hemophilia who present at the emergency department with head trauma. The algorithm, published in Pediatric Blood & Cancer, is intended to reduce these patients’ exposure to unnecessary discomfort and radiation.
“Management of hemophilia primarily focuses on the prevention and treatment of acute bleeding symptoms and their sequelae. Most concerning is the risk for serious, life-threatening bleeding, which includes intracranial hemorrhage (ICH),” the authors wrote.
“ICH can occur in pediatric patients secondary to vascular abnormalities, cardiac diseases, malignancies, bleeding disorders, and trauma whether accidental or non-accidental.”
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The researchers conducted a retrospective chart review of 89 visits and 43 patients in the emergency department by pediatric patients with hemophilia at a single US center between January 2007 and June 2019. The team employed the Pediatric Emergency Care Applied Research Network (PECARN) protocol, which helps clinicians distinguish patients with hemophilia at low risk of ICH, for whom CT scans might be unnecessary.
However, the authors propose revising the algorithm such that for pediatric patients with hemophilia and head trauma, PECARN recommendations would be utilized in those patients over 2 years of age and a CT scan would be performed in all patients under 2 years old.
The authors believe the proposed algorithm change would reduce the number of unnecessary CT scans and provide more clarity regarding the risk of ICH after head trauma in pediatric patients with hemophilia. At the same time, the algorithm would still capture potential cases of ICH, which could be life-threatening.
Kracht MJ, Stein A, Knoll C, et al. A proposed algorithm for evaluation and management of pediatric hemophilia patients who present to the emergency department with head trauma. Pediatr Blood Cancer. Published online June 16, 2022. doi:10.1002/pbc.29811