STUDY OBJECTIVE: Computed tomography (CT) is frequently used in evaluating children with blunt head trauma. Routine use of CT, however, has disadvantages. Therefore, we sought to derive a decision rule for identifying children at low risk for traumatic brain injuries. METHODS: We enrolled children with blunt head trauma at a pediatric trauma center in an observational cohort study between July 1998 and September 2001. We evaluated clinical predictors of traumatic brain injury on CT scan and traumatic brain injury requiring acute intervention, defined by a neurosurgical procedure, antiepileptic medications for more than 1 week, persistent neurologic deficits, or hospitalization for at least 2 nights. We performed recursive partitioning to create clinical decision rules. RESULTS: Two thousand forty-three children were enrolled, 1,271 (62%) underwent CT, 98 (7.7%; 95% confidence interval [CI] 6.3% to 9.3%) had traumatic brain injuries on CT scan, and 105 (5.1%; 95% CI 4.2% to 6.2%) had traumatic brain injuries requiring acute intervention. Abnormal mental status, clinical signs of skull fracture, history of vomiting, scalp hematoma (in children < or =2 years of age), or headache identified 97/98 (99%; 95% CI 94% to 100%) of those with traumatic brain injuries on CT scan and 105/105 (100%; 95% CI 97% to 100%) of those with traumatic brain injuries requiring acute intervention. Of the 304 (24%) children undergoing CT who had none of these predictors, only 1 (0.3%; 95% CI 0% to 1.8%) had traumatic brain injury on CT, and that patient was discharged from the ED without complications. CONCLUSION: Important factors for identifying children at low risk for traumatic brain injuries after blunt head trauma included the absence of: abnormal mental status, clinical signs of skull fracture, a history of vomiting, scalp hematoma (in children < or =2 years of age), and headache.
STUDY OBJECTIVE: Computed tomography (CT) is frequently used in evaluating children with blunt head trauma. Routine use of CT, however, has disadvantages. Therefore, we sought to derive a decision rule for identifying children at low risk for traumatic brain injuries. METHODS: We enrolled children with blunt head trauma at a pediatric trauma center in an observational cohort study between July 1998 and September 2001. We evaluated clinical predictors of traumatic brain injury on CT scan and traumatic brain injury requiring acute intervention, defined by a neurosurgical procedure, antiepileptic medications for more than 1 week, persistent neurologic deficits, or hospitalization for at least 2 nights. We performed recursive partitioning to create clinical decision rules. RESULTS: Two thousand forty-three children were enrolled, 1,271 (62%) underwent CT, 98 (7.7%; 95% confidence interval [CI] 6.3% to 9.3%) had traumatic brain injuries on CT scan, and 105 (5.1%; 95% CI 4.2% to 6.2%) had traumatic brain injuries requiring acute intervention. Abnormal mental status, clinical signs of skull fracture, history of vomiting, scalp hematoma (in children < or =2 years of age), or headache identified 97/98 (99%; 95% CI 94% to 100%) of those with traumatic brain injuries on CT scan and 105/105 (100%; 95% CI 97% to 100%) of those with traumatic brain injuries requiring acute intervention. Of the 304 (24%) children undergoing CT who had none of these predictors, only 1 (0.3%; 95% CI 0% to 1.8%) had traumatic brain injury on CT, and that patient was discharged from the ED without complications. CONCLUSION: Important factors for identifying children at low risk for traumatic brain injuries after blunt head trauma included the absence of: abnormal mental status, clinical signs of skull fracture, a history of vomiting, scalp hematoma (in children < or =2 years of age), and headache.
Authors: Angela Lumba-Brown; Keith Owen Yeates; Kelly Sarmiento; Matthew J Breiding; Tamara M Haegerich; Gerard A Gioia; Michael Turner; Edward C Benzel; Stacy J Suskauer; Christopher C Giza; Madeline Joseph; Catherine Broomand; Barbara Weissman; Wayne Gordon; David W Wright; Rosemarie Scolaro Moser; Karen McAvoy; Linda Ewing-Cobbs; Ann-Christine Duhaime; Margot Putukian; Barbara Holshouser; David Paulk; Shari L Wade; Stanley A Herring; Mark Halstead; Heather T Keenan; Meeryo Choe; Cindy W Christian; Kevin Guskiewicz; P B Raksin; Andrew Gregory; Anne Mucha; H Gerry Taylor; James M Callahan; John DeWitt; Michael W Collins; Michael W Kirkwood; John Ragheb; Richard G Ellenbogen; Theodore J Spinks; Theodore G Ganiats; Linda J Sabelhaus; Katrina Altenhofen; Rosanne Hoffman; Tom Getchius; Gary Gronseth; Zoe Donnell; Robert E O'Connor; Shelly D Timmons Journal: JAMA Pediatr Date: 2018-11-05 Impact factor: 16.193
Authors: C Fundarò; M Caldarelli; S Monaco; F Cota; V Giorgio; S Filoni; C Di Rocco; R Onesimo Journal: Childs Nerv Syst Date: 2012-02-15 Impact factor: 1.475