Dr. Kuppermann and his team first collected data from over 33,000 children with head trauma, and then fed the figures into a computer. Their software worked out what the six most important predictors of brain injury were. Dr. Kuppermann then looked at a second population of around 9,000 children, and found if they didn't have those risk factors, the danger of serious brain injury was extremely small.

The researchers also identified separate risk factors for children under two, as they realized diagnosing brain injury in pre-verbal children is a unique challenge.


"They can't tell you if they have amnesia or a headache, among other things," Dr. Kuppermann says.

The study argues that the risk of missing a brain injury in the absence of the six risk factors would be lower than the risk of developing a lethal cancer from undergoing an unnecessary CT scan. For children younger than two, there's a one in 5,000 chance an injury would be missed. For older than two, it's one in 2,000.

"What is a reasonable risk?" Dr. Kuppermann asks. "Is it one in a 100, one in a 1,000? The answers to these questions greatly depend of the values and preferences of the physicians and the patients."

"With just six variables you're never going to capture everybody," he says. "But the truth is, these prediction rules aren't meant to replace clinician judgment. This empowers clinician judgment."


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