医学と法学の両視点から軽症小児頭部外傷患者に対する頭部CT検査の適否を考える

抄録

Background: Children with minor head injury have a low, but serious risk of traumatic intracranial haemor­rhage. Medical research on criteria for head computerized tomo­graphy (CT) examinations for children is still inconclusive, because CT scanning is required to identify severe traumatic head injury, including acute epidural haematoma. However, radiation exposure is also an important problem.

From the medical perspective the decision to take neuro-imaging, including CT examination, for children with minor head injury must be made carefully, because of the possibility of negative impact on cognitive abilities or an increased risk of cancer from ionizing radiation.

From the legal perspective, when a pediatric patient with a minor head injury who did not have a CT head examination performed at the discretion of a doctor, but died several hours later from a traumatic intra­cranial haemorrhage, the doctor who had failed to order the head CT examination could be sued for medical malpractice. On the other hand, even if decreased cognitive abilities or an increased cancer risk occur more than a decade after that radiation exposure in a patient who had a head CT examina­tion during childhood because of minor head trauma, a doctor who ordered the CT examination is not at risk of being sued for medical malpractice.

Conclusion: A balanced judgment between medical and legal problems of medical care must be made. In other words, medical issues related to society, like the criteria for the CT scanning of children with a minor head injury, must be considered carefully.