OBJECTIVES: To develop a sensitive clinical decision rule with a high negative predictive value for the use of cranial computed tomography (CT) in minor pediatric head trauma, to identify clinical features predictive of neurosurgical intervention, and to assess clinicians' predictive abilities to determine the presence or absence of intracranial injury based on history and physical examination alone. DESIGN: Prospective observational study. SETTING: Four level I pediatric trauma centers. PARTICIPANTS: One thousand patients younger than 21 years with minor head trauma undergoing cranial CT. MAIN OUTCOME MEASURE: Intracranial injury as demonstrated by CT and neurosurgical intervention. RESULTS: Of 1000 patients in the study, the mean age was 8.9 years, and 64.1% were male; 6.5% (65 of 1000) had positive findings on CT, and 9.2% (6 of 65) of these required neurosurgical intervention. Recursive partitioning identified the following variables in the decision rule: dizziness, skull defect, sensory deficit, mental status change, bicycle-related injury, age younger than 2 years, Glasgow Coma Scale score less than 15, and evidence of a basilar skull fracture. For detection of intracranial injury, the decision rule had a sensitivity of 95.4% (95% confidence interval [CI], 86.2%-98.8%), a specificity of 48.9% (95% CI, 46.6%-52.1%), and a negative predictive value of 99.3% (95% CI, 98.1%-99.8%). CONCLUSIONS: We developed a sensitive clinical decision rule with a high NPV for detection of intracranial injury in minor pediatric head trauma. If validated, this rule could provide a useful adjunct to the physician's clinical assessment by reducing variations in practice and unnecessary cranial CT.
OBJECTIVES: To develop a sensitive clinical decision rule with a high negative predictive value for the use of cranial computed tomography (CT) in minor pediatric head trauma, to identify clinical features predictive of neurosurgical intervention, and to assess clinicians' predictive abilities to determine the presence or absence of intracranial injury based on history and physical examination alone. DESIGN: Prospective observational study. SETTING: Four level I pediatric trauma centers. PARTICIPANTS: One thousand patients younger than 21 years with minor head trauma undergoing cranial CT. MAIN OUTCOME MEASURE: Intracranial injury as demonstrated by CT and neurosurgical intervention. RESULTS: Of 1000 patients in the study, the mean age was 8.9 years, and 64.1% were male; 6.5% (65 of 1000) had positive findings on CT, and 9.2% (6 of 65) of these required neurosurgical intervention. Recursive partitioning identified the following variables in the decision rule: dizziness, skull defect, sensory deficit, mental status change, bicycle-related injury, age younger than 2 years, Glasgow Coma Scale score less than 15, and evidence of a basilar skull fracture. For detection of intracranial injury, the decision rule had a sensitivity of 95.4% (95% confidence interval [CI], 86.2%-98.8%), a specificity of 48.9% (95% CI, 46.6%-52.1%), and a negative predictive value of 99.3% (95% CI, 98.1%-99.8%). CONCLUSIONS: We developed a sensitive clinical decision rule with a high NPV for detection of intracranial injury in minor pediatric head trauma. If validated, this rule could provide a useful adjunct to the physician's clinical assessment by reducing variations in practice and unnecessary cranial CT.
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
Authors: Martin H Osmond; Terry P Klassen; George A Wells; Rhonda Correll; Anna Jarvis; Gary Joubert; Benoit Bailey; Laurel Chauvin-Kimoff; Martin Pusic; Don McConnell; Cheri Nijssen-Jordan; Norm Silver; Brett Taylor; Ian G Stiell Journal: CMAJ Date: 2010-02-08 Impact factor: 8.262
Authors: Martin H Osmond; Terry P Klassen; George A Wells; Jennifer Davidson; Rhonda Correll; Kathy Boutis; Gary Joubert; Serge Gouin; Simi Khangura; Troy Turner; Francois Belanger; Norm Silver; Brett Taylor; Janet Curran; Ian G Stiell Journal: CMAJ Date: 2018-07-09 Impact factor: 8.262