Can an abnormal CT scan be predicted from common symptoms after mild head injury in children?

Munivenkatappa, Ashok; Deepika, Akhil; Prathyusha, Vasuki; Devi, Indira; Shukla, Dhaval

doi:10.4103/1817-1745.123659

Cited by 8 publications

(8 citation statements)

References 17 publications

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“…As a means of comparison, GCS has been shown to have an ROC between 0.77 and 0.88 for predicting mortality in severe TBI 32 33 and an ROC of 0.446–0.643 in mild TBI for predicting abnormal CT findings. 34 This places the ROC for the tested variables in line with other prediction models. While not more accurate than GCS by ROC criteria, this test is more objective and in theory may be less subject to misinterpretation than the GCS.…”

Section: Discussionsupporting

confidence: 76%

Through the looking glass: early non-invasive imaging in TBI predicts the need for interventions

Glaser

Vasquez

Cardarelli

et al. 2016

Trauma Surg Acute Care Open

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BackgroundEarly diagnosis and treatment of traumatic brain injury (TBI) lead to better outcomes. It is difficult to predict which patients benefit from specialised centres, leading to over triage or delay in definitive care. We propose that a non-invasive test comprising optic nerve sheath ultrasound, transcranial Doppler and quantitative papillary reactivity is feasible, correlates with CT findings and may allow for accurate early identification of TBI.MethodsA 1-year, prospective observation study evaluated a low-risk, non-invasive method of assessing brain injury. Patients underwent a non-invasive neurological examination for trauma, including the above assessments. Data from the three examinations were collected within 6 hours of injury and at 24 hours, and were analysed. Demographics, haemodynamic data, imaging results and short-term outcomes/interventions were recorded.ResultsTrauma patients over the age of 18 years, with a Glascow coma scale (GCS) of <12 or CT evidence of TBI, and intubated were included (N=100). These were divided into +CT (n=49) and −CT groups (n=51) according to the Marshall CT classification of TBI. The +CT group was older, with worse GCS and higher lactate (p=0.008, p=0.001 and p=0.01) but were otherwise well matched. The +CT group included all TBI types, with 96% of the patients having more than one type of TBI. Pulsatility index and neurologic pupillary index were predictive of a +CT (p=0.04, p=0.02). Area under the receiver-operating curve for the logistic regression model for the prediction of positive radiographic findings was r=0.718. Finally, we suggest a preliminary scoring heuristic for predicting a positive radiological finding in a patient with TBI.ConclusionsThe proposed examination is a feasible, non-invasive tool that may have clinical utility in the early prediction of TBI. If validated, it may improve trauma triage for the brain-injured patient. Further studies are warranted to validate this model.

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Section: Discussionsupporting

confidence: 76%

Through the looking glass: early non-invasive imaging in TBI predicts the need for interventions

Glaser

Vasquez

Cardarelli

et al. 2016

Trauma Surg Acute Care Open

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“…There was no upgrading of the evidence level. The recommendation was perceived as strong when considering the relatively low prevalence of the predictive factors compared to the severe influence on patient outcome if the patients with ICI or a neurosurgical lesion were missed; (a) [ 8 , 22 , 48 , 51 – 53 , 61 – 73 ], (b) [ 22 , 48 , 49 , 51 – 53 , 55 , 63 – 65 , 67 – 78 ].…”

Section: Resultsmentioning

confidence: 99%

“…The evidence for prolonged LOC (≥1 min) [ 7 , 22 , 48 , 49 , 52 – 54 , 67 , 71 , 83 ] as a predictive factor for intracranial complications was slightly higher (low evidence) than for unspecified LOC (very low evidence) [ 6 – 8 , 48 , 49 , 51 , 53 , 55 , 60 – 65 , 68 , 70 – 75 , 78 – 80 , 83 – 86 ]. This is mainly due to imprecision and indirectness, and with a very high prevalence of the risk factor in some studies.…”

Section: Resultsmentioning

confidence: 99%

Scandinavian guidelines for initial management of minor and moderate head trauma in children

Åstrand

Rosenlund

Undén

2016

BMC Med

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BackgroundThe management of minor and moderate head trauma in children differs widely between countries. Presently, there are no existing guidelines for management of these children in Scandinavia. The purpose of this study was to produce new evidence-based guidelines for the initial management of head trauma in the paediatric population in Scandinavia. The primary aim was to detect all children in need of neurosurgical intervention. Detection of any traumatic intracranial injury on CT scan was an important secondary aim.MethodsGeneral methodology according to the Appraisal of Guidelines for Research and Evaluation (AGREE) II and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system was used. Systematic evidence-based review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology and based upon relevant clinical questions with respect to patient-important outcomes. Quality ratings of the included studies were performed using Quality Assessment of Diagnostic Accuracy Studies (QUADAS)-2 and Centre of Evidence Based Medicine (CEBM)-2 tools. Based upon the results, GRADE recommendations, a guideline, discharge instructions and in-hospital observation instructions were drafted. For elements with low evidence, a modified Delphi process was used for consensus, which included relevant clinical stakeholders.ResultsThe guidelines include criteria for selecting children for CT scans, in-hospital observation or early discharge, and suggestions for monitoring routines and discharge advice for children and guardians. The guidelines separate mild head trauma patients into high-, medium- and low-risk categories, favouring observation for mild, low-risk patients as an attempt to reduce CT scans in children.ConclusionsWe present new evidence and consensus based Scandinavian Neurotrauma Committee guidelines for initial management of minor and moderate head trauma in children. These guidelines should be validated before extensive clinical use and updated within four years due to rapid development of new diagnostic tools within paediatric neurotrauma.Electronic supplementary materialThe online version of this article (doi:10.1186/s12916-016-0574-x) contains supplementary material, which is available to authorized users.

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“…This is consistent with findings of Munivenkatappa et al . [ 30 ] who studied predictors of CT positivity in pediatric population (age >12 years). Nasal bleed was found to be significantly associated with CT positivity in our study.…”

Section: Discussionmentioning

confidence: 99%

Computed Tomography Profile and its Utilization in Head Injury Patients in Emergency Department: A Prospective Observational Study

Waganekar

Jagadish

Prabhu

et al. 2018

J Emerg Trauma Shock

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Context:Based on Glasgow Coma Scale (GCS), head injury can be classified as minor (GCS 13–15), moderate (GCS 9–12), and severe (GCS 3–8). There is a lot of controversy in the use of computed tomography (CT) in head injury patients.Aims:This study was intended to estimate the rate of CT positivity in head injury patients and to define the criteria for doing CT in head injury patients.Settings and Design:This was a prospective observational study in the emergency department (ED) over a 12-month period. Subjects andMethods:Study involved all head injury patients attending ED. Risk factors studied were a loss of consciousness (LOC), vomiting, seizures, ear bleed, nosebleed, external injuries, and alcohol intoxication.Statistical Analysis Used:Comparison of CT positivity with the patient's demographics and clinical characteristics was carried out using Chi-square.Results:A total of 1782 patients were included in this study. Overall CT positivity was 50.9%. In minor head injury (MHI), CT positivity rate was 38%. The study showed significant association of CT positivity with five variables: LOC >5 min, vomiting, seizures, ear bleed, and nosebleed.Conclusions:From the study, we recommend following: CT is indicated in all patients with moderate and severe head injury (GCS ≤12). Low threshold for taking CT is advisable in elderly and alcohol-intoxicated patients. In MHI, CT is indicated if any one of the following risk factors are present: LOC >5 min, history of vomiting, history of seizures, history of ear bleed, and history of nosebleed.

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Can an abnormal CT scan be predicted from common symptoms after mild head injury in children?

Cited by 8 publications

References 17 publications

Through the looking glass: early non-invasive imaging in TBI predicts the need for interventions

Through the looking glass: early non-invasive imaging in TBI predicts the need for interventions

Scandinavian guidelines for initial management of minor and moderate head trauma in children

Computed Tomography Profile and its Utilization in Head Injury Patients in Emergency Department: A Prospective Observational Study

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