Prediction of intracranial injury in children aged five years and older with loss of consciousness after minor head injury due to nontrivial mechanisms☆
Received 23 September 2002; received in revised form 8 April 2003; accepted 16 May 2003.
Refers to article:
A decision rule for identifying children at low risk for brain injuries after blunt head trauma
Michael J. Palchak, James F. Holmes, Cheryl W. Vance, Rebecca E. Gelber, Bobbie A. Schauer, Mathew J. Harrison, Jason Willis-Shore, Sandra L. Wootton-Gorges, Robert W. Derlet, Nathan Kuppermann
Annals of Emergency Medicine
October 2003 (Vol. 42, Issue 4, Pages 492-506) Abstract |
Full Text |
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Decisionmaking in pediatric minor head trauma
David S Greenes
Annals of Emergency Medicine
October 2003 (Vol. 42, Issue 4, Pages 515-518) Full Text |
Full-Text PDF (67 KB)
Abstract
Study objective
Indications for computed tomography (CT) in children with minor head injury remain controversial. The objective of this preliminary study is to determine whether a clinical decision rule developed for adults could be used in children aged 5 years and older.
Methods
A prospective questionnaire was completed on all patients who were aged 5 to 17 years with major mechanisms of injury resulting in minor head injury (defined as normal Glasgow Coma Scale or modified coma scale in infants, plus normal brief neurologic examination) and loss of consciousness. The questionnaire documented 6 clinical variables: headache, emesis, intoxication, seizure, short-term memory deficits, and physical evidence of trauma above the clavicles. CT was obtained for all patients, findings were compared with the results of the questionnaires, and the sensitivity and specificity of the decision rule were determined.
Results
Throughout a 30-month period, 175 patients were enrolled, with a mean age of 12.8 years. Fourteen (8%) patients had intracranial injury or depressed skull fracture on CT. The presence of any of the 6 criteria was significantly associated with an abnormal CT scan result (P<.05) and was 100% (95% confidence interval 73% to 100%) sensitive for identifying patients with intracranial injury.
Conclusion
In this preliminary study, CT use in pediatric patients with minor head injury could have been safely reduced by 23% by using a clinical decision rule previously validated in adults.
Section of Emergency Medicine, Louisiana State University Health Science Center at New Orleans, New Orleans, LA, USA
Address for correspondence: Micelle J. Haydel, MD, Emergency Medicine Office, Charity Hospital, 13th Floor, 1532 Tulane Avenue, New Orleans, LA 70112; 504-903-1006
☆ Author contributions: MJH conceived the study, designed and supervised data collection, provided statistical analysis, and drafted the manuscript. ADS participated in data collection, data management, and data quality control and contributed to manuscript revisions. MJH takes responsibility for the paper as a whole.
The authors report this study did not receive any outside funding or support.
ABSTRACT