STUDY OBJECTIVE: To assess clinical features that might reliably predict the need for computed tomography (CT) imaging in pediatric head trauma. DESIGN/SETTING/TYPE OF PARTICIPANT: Prospective cohort of 324 head CT scans performed on 322 consecutive trauma patients at an urban children's hospital. RESULTS: Sixty-two percent of patients were male. The mean age was 7.1 years (10 days to 20.6 years); half were less than 5 years of age. The two most frequent mechanisms of injury were falls (32%) and motor vehicle accidents (25%). Abnormalities were detected in 74 scans. Intracranial injuries were apparent in 39 patients (12%); 16 had a concomitant fracture. An isolated cranial abnormality was observed on 35 scans (11%). Loss of consciousness, amnesia for the event, a Glasgow Coma Scale (GCS) of less than 15, and the presence of a neurologic deficit were more common in children with intracranial injury (P < .05). Vomiting, seizures, and headache were not discriminating clinical features. No single characteristic consistently identified the children with an intracranial injury. Of the 195 children who were neurologically intact (GCS, 15) at the time of presentation, 11 (5%) had evidence of intracranial pathology on CT scan. CONCLUSION: This study demonstrates a poor correlation between the clinical symptoms of significant traumatic brain injury and findings on CT.
STUDY OBJECTIVE: To assess clinical features that might reliably predict the need for computed tomography (CT) imaging in pediatric head trauma. DESIGN/SETTING/TYPE OF PARTICIPANT: Prospective cohort of 324 head CT scans performed on 322 consecutive traumapatients at an urban children's hospital. RESULTS: Sixty-two percent of patients were male. The mean age was 7.1 years (10 days to 20.6 years); half were less than 5 years of age. The two most frequent mechanisms of injury were falls (32%) and motor vehicle accidents (25%). Abnormalities were detected in 74 scans. Intracranial injuries were apparent in 39 patients (12%); 16 had a concomitant fracture. An isolated cranial abnormality was observed on 35 scans (11%). Loss of consciousness, amnesia for the event, a Glasgow Coma Scale (GCS) of less than 15, and the presence of a neurologic deficit were more common in children with intracranial injury (P < .05). Vomiting, seizures, and headache were not discriminating clinical features. No single characteristic consistently identified the children with an intracranial injury. Of the 195 children who were neurologically intact (GCS, 15) at the time of presentation, 11 (5%) had evidence of intracranial pathology on CT scan. CONCLUSION: This study demonstrates a poor correlation between the clinical symptoms of significant traumatic brain injury and findings on 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: Matthias Hohlrieder; Josef Hinterhoelzl; Hanno Ulmer; Christiane Lang; Wolfgang Hackl; Andreas Kampfl; Arnulf Benzer; Erich Schmutzhard; Robert Gassner Journal: Intensive Care Med Date: 2003-05-24 Impact factor: 17.440
Authors: Jonas G Halldorsson; Kjell M Flekkoy; Kristinn R Gudmundsson; Gudmundur B Arnkelsson; Eirikur Orn Arnarson Journal: Neuropsychiatr Dis Treat Date: 2007-12 Impact factor: 2.570