Derivation and validation of a clinical decision rule to identify young children with skull fracture following isolated head trauma

Managing isolated head trauma in young children

“…In most cases, clinicians must exercise professional judgment to determine if radiologic evaluation is warranted, but they can rest assured that the likelihood of skull fracture is well below 1%. 1 The low prevalence of clinically significant injuries in young children is consistent with a secondary analysis of PECARN data. 10 When no imaging is ordered, precise discharge instructions are paramount.…”

“…1 The prospective observational study asks an important clinical question and elegantly incorporates a previously validated and extensively used clinical decision rule. The authors provide front-line clinicians with objective decision-making criteria, more helpful than "observation versus CT." 6 But perhaps most important, the rule is simple: in children less than two years old with a minor head injury who do not meet the criteria for a CT scan, perform a skull radiograph if they are less than two months old or they have parietal or occipital swelling.…”

“…1 Head trauma in children is common, leading to more than 20 000 emergency department visits each year in Canada and more than 470 000 in the United States. 2 Although most head injuries are benign, important complications include skull fracture and traumatic brain injury.…”

“…8 Gravel and colleagues' study helps to resolve this uncertainty. 1 Between 2011 and 2014, 1667 children aged less than two years were enrolled within 24 hours after their head injury: 811 in the derivation cohort and 856 in the validation cohort. Children were not eligible if they met criteria for a CT scan (i.e., Glasgow Coma Scale score < 14 or high risk of mild traumatic brain injury according to the PECARN rule), the clinician suspected child abuse or prior imaging had been obtained.…”

Risk Stratification Model: Lower-Extremity Ultrasonography for Hospitalized Patients with Suspected Deep Vein Thrombosis

“…We used recursive partitioning to find the best combinations of predictor variables that were sensitive for detecting DVT. Recursive partitioning is a statistical method for multivariable analysis that uses decision tree to classify members of a population by splitting it into sub-populations based on independent variables, and has been used in the development of other clinical decision rules [6][7][8] . Quantitative variables were converted to binary by JMP Pro 10 (SAS Institute Inc., Cary, NC, USA), which minimized entropy.…”