Children with recent substance or alcohol use were less likely to have findings that prompted further testing, treatment, or admission (known as important findings) on their brain scans, but no other signs or symptoms were clearly linked to having important findings, according to a study published in Academic Emergency Medicine.   

“This study shows that brain scans are infrequently helpful for evaluating symptoms of psychosis in children in the emergency department, particularly when there are no concerning signs or symptoms that might suggest a need for neuroimaging,” said study author Jennifer Hoffmann, MD, MS, Attending Physician of Emergency Medicine at Ann & Robert H. Lurie Children’s Hospital of Chicago and Assistant Professor of Pediatrics (Emergency Medicine) at Northwestern University Feinberg School of Medicine. “These findings might inform guidelines for evaluation of psychosis and might also contribute to lowering costs of care by avoiding unnecessary testing.”   

For the multicenter retrospective analysis, which included Lurie Children’s, the researchers sought to identify specific signs and symptoms that were associated with having important findings on brain scans. They studied children who presented to 28 emergency departments in the United States and Canada for symptoms of psychosis, such as hallucinations or delusions, and who had neuroimaging (brain scans) obtained as part of their diagnostic work-up. They found that the brain scans revealed important findings in about 1 in 20 cases. Among patients who did not have any concerning signs or symptoms such as a headache or vomiting that might prompt ordering a brain scan, fewer than 1 in 100 cases had important neuroimaging findings that were likely related to the child’s presenting symptoms. 

The study relied on review of medical records, so the researchers were only able to assess findings among children who had brain scans performed, explained Dr. Hoffmann. The study’s authors reported that studies that enroll children within the emergency department are needed to generate more accurate estimates of the utility of brain scans for evaluation of symptoms of psychosis. 

Pediatric research at Ann & Robert H. Lurie Children’s Hospital of Chicago is conducted through Stanley Manne Children’s Research Institute.