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Decide on neuroimaging after a paediatric head injury — OSCE
OSCE communication and decision-making station: apply the PECARN head injury prediction rule to a 3-year-old after a fall, decide on imaging, counsel the parent about the radiation risk of a head CT, and apply the ALARA principle.
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You have this station to assess a 3-year-old boy after a fall, decide whether he needs neuroimaging using the validated PECARN prediction rule, and counsel his anxious parent about the radiation risk of a head CT and the reasoning behind your decision. Treat this as a communication and decision-making encounter: take a focused history, apply the rule explicitly, communicate the decision and the safety-net clearly, and demonstrate radiation-aware reasoning. [1] [4]
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- [1]Kuppermann N, Holmes JF, Dayan PS, et al Identification of children at very low risk of clinically-important brain injuries after head trauma: a prospective cohort study Lancet, 2009.PMID 19758692
- [2]Brenner D, Elliston C, Hall E, Berdon W Estimated risks of radiation-induced fatal cancer from pediatric CT AJR Am J Roentgenol, 2001.PMID 11159059
- [3]Pearce MS, Salotti JA, Little MP, et al Radiation exposure from CT scans in childhood and subsequent risk of leukaemia and brain tumours: a retrospective cohort study Lancet, 2012.PMID 22681860
- [4]Frush DP, Frush KS The ALARA concept in pediatric imaging: building bridges between radiology and emergency medicine Pediatr Radiol, 2008.PMID 18810422