Silvia Bressan1,2, Paul Monagle1,3,4, Stuart R Dalziel5,6, Meredith L Borland7,8, Natalie Phillips9,10, Amit Kochar11, Mark D Lyttle1,12,13, John A Cheek1,3,14, Jocelyn Neutze15, Ed Oakley1,3,4, Sarah Dalton16, Yuri Gilhotra9, Stephen Hearps1, Jeremy Furyk17, Franz E Babl1,3,4. 1. Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia. 2. Department of Women's and Children's Health, University of Padova, Padova, Italy. 3. Emergency Department, Royal Children's Hospital, Melbourne, Victoria, Australia. 4. Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia. 5. Emergency Department, Starship Children's Health, Auckland, New Zealand. 6. Departments of Surgery and Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand. 7. Emergency Department, Perth Children's Hospital, Perth, Western Australia, Australia. 8. Divisions of Paediatrics and Emergency Medicine, School of Medicine, University of Western Australia, Perth, Western Australia, Australia. 9. Emergency Department, Children's Hospital Queensland, Brisbane, Queensland, Australia. 10. Child Health Research Centre, School of Medicine, University of Queensland, Centre for Children's Health Research, Brisbane, Queensland, Australia. 11. Emergency Department, Women's and Children's Hospital, Adelaide, South Australia, Australia. 12. Emergency Department, Bristol Children's Hospital, Bristol, UK. 13. Academic Department of Emergency Care, University of the West of England, Bristol, UK. 14. Emergency Department, Monash Medical Centre, Melbourne, Victoria, Australia. 15. Emergency Department, Kidzfirst Middlemore Hospital, Auckland, New Zealand. 16. Emergency Department, The Children's Hospital at Westmead, Sydney, New South Wales, Australia. 17. Emergency Department, The Townsville Hospital, Townsville, Queensland, Australia.
Abstract
AIM: To assess computerised tomography (CT) use and the risk of intracranial haemorrhage (ICH) in children with bleeding disorders following a head trauma. METHODS: Design: Multicentre prospective observational study. SETTING: 10 paediatric emergency departments (ED) in Australia and New Zealand. PATIENTS: Children <18 years with and without bleeding disorders assessed in ED following head trauma between April 2011 and November 2014. INTERVENTIONS: Data collection of patient characteristics, management and outcomes. MAIN OUTCOME MEASURES: Rate of CT use and frequency of ICH on CT. RESULTS: Of 20 137 patients overall, 103 (0.5%) had a congenital or acquired bleeding disorder. CT use was higher in these patients compared with children without bleeding disorders (30.1 vs. 10.4%; rate ratio 2.91 95% CI 2.16-3.91). Only one of 31 (3.2%) children who underwent CT in the ED had an ICH. This patient rapidly deteriorated in the ED on arrival and required neurosurgery. None of the patients with bleeding disorders who did not have a CT obtained in the ED or had an initial negative CT had evidence of ICH on follow up. CONCLUSIONS: Although children with a bleeding disorder and a head trauma more often received a CT scan in the ED, their risk of ICH seemed low and appeared associated with post-traumatic clinical findings. Selective CT use combined with observation may be cautiously considered in these children based on clinical presentation and severity of bleeding disorder.
AIM: To assess computerised tomography (CT) use and the risk of intracranial haemorrhage (ICH) in children with bleeding disorders following a head trauma. METHODS: Design: Multicentre prospective observational study. SETTING: 10 paediatric emergency departments (ED) in Australia and New Zealand. PATIENTS: Children <18 years with and without bleeding disorders assessed in ED following head trauma between April 2011 and November 2014. INTERVENTIONS: Data collection of patient characteristics, management and outcomes. MAIN OUTCOME MEASURES: Rate of CT use and frequency of ICH on CT. RESULTS: Of 20 137 patients overall, 103 (0.5%) had a congenital or acquired bleeding disorder. CT use was higher in these patients compared with children without bleeding disorders (30.1 vs. 10.4%; rate ratio 2.91 95% CI 2.16-3.91). Only one of 31 (3.2%) children who underwent CT in the ED had an ICH. This patient rapidly deteriorated in the ED on arrival and required neurosurgery. None of the patients with bleeding disorders who did not have a CT obtained in the ED or had an initial negative CT had evidence of ICH on follow up. CONCLUSIONS: Although children with a bleeding disorder and a head trauma more often received a CT scan in the ED, their risk of ICH seemed low and appeared associated with post-traumatic clinical findings. Selective CT use combined with observation may be cautiously considered in these children based on clinical presentation and severity of bleeding disorder.