Prediction of intracranial injury in children aged five years and older with loss of consciousness after minor head injury due to nontrivial mechanisms☆

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.