Identification of children at very low risk of clinically-important brain injuries after head trauma: a prospective cohort study

Kuppermann, Nathan; Holmes, James F.; Dayan, Peter; Hoyle, John D.; Atabaki, Shireen M.; Holubkov, Richard; Nadel, Frances M.; Monroe, David; Stanley, Rachel; Borgialli, Dominic; Badawy, Mohamed; Schunk, Jeff E.; Quayle, Kimberly S.; Mahajan, Prashant; Lichenstein, Richard; Lillis, Kathleen; Tunik, Michael G.; Jacobs, Elizabeth; Callahan, James M.; Gorelick, Marc H.; Glass, Todd F.; Lee, Lois K.; Bachman, Michael C.; Cooper, Arthur; Powell, Elizabeth C.; Gerardi, Michael; Melville, K.; Muizelaar, J. Paul; Wisner, David H.; Zuspan, Sally Jo; Dean, J. Michael; Wootton‐Gorges, Sandra L.

doi:10.1016/s0140-6736(09)61558-0

Cited by 1,357 publications

(1,685 citation statements)

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“…5,17 The Pediatric Emergency Care Applied Research Network (PECARN) was established to overcome the barriers of conducting research pertaining to acutely ill and injured children during all phases of emergency care and has a history of successful completion of large multicenter clinical trials. [18][19][20][21][22][23][24][25] Due to the promising preclinical and phase II studies for the use of progesterone for adult TBI, PECARN investigators were funded to conduct feasibility planning for a clinical trial of progesterone and other promising agents for TBI in children. 26 In this article we report a prospective observational feasibility study of children with moderate-to-severe TBI presenting to 16 pediatric EDs across the United States.…”

Section: Resultsmentioning

confidence: 99%

Challenges Enrolling Children Into Traumatic Brain Injury Trials: An Observational Study

Stanley

Johnson

Vance

et al. 2017

Academic Emergency Medicine

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Objectives: In preparation for a clinical trial of therapeutic agents for children with moderate-to-severe blunt traumatic brain injuries (TBIs) in emergency departments (EDs), we conducted this feasibility study to (1) determine the number and clinical characteristics of eligible children, (2) determine the timing of patient and guardian arrival to the ED, and (3) describe the heterogeneity of TBIs on computed tomography (CT) scans. Methods:We conducted a prospective observational study at 16 EDs of children ≤ 18 years of age presenting with blunt head trauma and Glasgow Coma Scale scores of 3-12. We documented the number of potentially eligible patients, timing of patient and guardian arrival, patient demographics and clinical characteristics, severity of injuries, and cranial CT findings.

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Section: Resultsmentioning

confidence: 99%

Challenges Enrolling Children Into Traumatic Brain Injury Trials: An Observational Study

Stanley

Johnson

Vance

et al. 2017

Academic Emergency Medicine

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“…Current literature underscores the overuse of CT scans for injured children [19][20][21] and the link between CT use in the pediatric population and overall increased lifetime risk of cancer [22,23]. In response, multiple triage algorithms emphasizing monitored observation, plain radiography and decreased CT usage have been developed [24][25][26]. For example, clinical algorithms such as CATCH [26], a Canadian decision tool stratifying mildly injured children into high and medium risk for head injury, predicts optimal head CT scan rates of 30% and 52% respectively.…”

Section: Discussionmentioning

confidence: 99%

Academic-community partnerships improve outcomes in pediatric trauma care

Kelley-Quon¹,

Crowley²,

Applebaum³

et al. 2015

Journal of Pediatric Surgery

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a b s t r a c t a r t i c l e i n f oBackground: To address the specialized needs of injured children, pediatric trauma centers (PTCs) were established at many large, academic hospitals. This study explores clinical outcomes observed for injured children treated at an academic-sponsored community facility. Methods: In partnership with an academic medical center in a major metropolitan area, a not-for-profit community hospital became a designated Level II PTC in October 2010. Data for injured children b15 years old treated prior to PTC designation from January 2000 to September 2010 were prospectively collected using the Trauma and Emergency Medicine Information System and compared to data collected after PTC designation from January 2011 to December 2013. Results: Overall, 681 injured children were treated at the community hospital from January 2011 to December 2013. Children treated after PTC designation were less likely to undergo computed tomography (CT) (50.9% vs. 81.3%, p b 0.01), even when controlling for age, gender, injury type, injury severity, and year (OR 0.18, 95%CI 0.08-0.37). Specifically, fewer head (45.7% vs. 68.7%, p b 0.01) and abdominal CTs (13.2% vs. 26.5%, p b 0.01) were performed. Hospital length of stay was significantly shorter (2.8 ± 3.7 days vs. 3.7 ± 5.9 days, p b 0.01). Mortality was low overall, but also decreased after PTC designation (0.4% vs. 2.0%, p = 0.02). Conclusions: These results indicate that academic-community partnerships in pediatric trauma care are a feasible alternative and may lead to improved outcomes for injured children.

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“…12,13 Variability could also be explained by factors beyond the probability of injury that affect the balance of risks and benefits for a specific patient. For example, recent studies have highlighted the increased risk of harm for younger patients from ionizing radiation used in CT. 14,15 We did not find effect modification by age on the relationship between estimated probability and decisions, but physicians did underestimate the risk of pathology in children less than 1 year.…”

Section: Discussionmentioning

confidence: 99%

Accuracy of physician-estimated probability of brain injury in children with minor head trauma

Daymont

Klassen

Osmond

2015

CJEM

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Objective: To evaluate the accuracy of physician estimates of the probability of intracranial injury in children with minor head trauma. Methods: This is a subanalysis of a large prospective multicentre cohort study performed from July 2001 to November 2005. During data collection for the derivation of a clinical prediction rule for children with minor head trauma, physicians indicated their estimate of the probability of brain injury visible on computed tomography (P-Injury) and the probability of injury requiring intervention (P-Intervention) by choosing one of the following options: 0%, 1%, 2%, 3%, 4%, 5%, 10%, 20%, 30%, 40%, 50%, 75%, 90%, and 100%. We compared observed frequencies to expected frequencies of injury using Pearson's χ 2 -test in analyses stratified by the level of each type of predicted probability and by year of age. Results: In 3771 eligible subjects, the mean predicted risk was 4.6% (P-Injury) and 1.4% (P-Intervention). The observed frequency of injury was 4.1% (any injury) and 0.6% (intervention). For all levels of P-Injury from 1% to 40%, the observed frequency of injury was consistent with the expected frequency. The observed frequencies for the 50%, 75%, and 90% levels were lower than expected (p < 0.05). For estimates of P-Intervention, the observed frequency was consistently higher than the expected frequency. Physicians underestimated risk for infants (mean P-Intervention 6.2%, actual risk 12.3%, p < 0.001). Conclusions: Physician estimates of probability of any brain injury in children were collectively accurate for children with low and moderate degrees of predicted risk. Risk was underestimated in infants. RÉSUMÉObjectif: L'étude visait à évaluer l'exactitude de l'estimation, faite par les médecins, du risque de lésion intracrânienne chez les enfants ayant subi un trauma léger à la tête. Résultats: Le risque moyen prévu chez 3771 sujets admissibles était de 4,6 % (P lésion) et de 1,4 % (P intervention). Quant à la fréquence observée des lésions, elle s'élevait à 4,1 % pour l'ensemble des lésions et à 0,6 % pour les interventions. En ce qui concerne la fréquence observée des lésions, elle correspondait à la fréquence prévue, et ce, à toutes les valeurs variant de 1 % à 40 %; pour ce qui est de la fréquence observée aux valeurs de 50 %, 75 % et 90 %, elle était inférieure à la fréquence prévue (p < 0,05). En ce qui concerne l'estimation des probabilités d'intervention, la fréquence observée était toujours plus élevée que la fré-quence prévue. Enfin, les médecins sous-estimaient le risque chez les nourrissons (P intervention moyenne: 6,2 %; risque réel: 12,3 %; p < 0,001). Conclusions: L'estimation, faite par les médecins, du risque de lésion cérébrale chez les enfants était exacte, dans l'ensemble, chez les blessés ayant un risque prévu faible ou moyen; par contre, le risque était sous-estimé chez les nourrissons.

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Identification of children at very low risk of clinically-important brain injuries after head trauma: a prospective cohort study

Cited by 1,357 publications

References 36 publications

Challenges Enrolling Children Into Traumatic Brain Injury Trials: An Observational Study

Challenges Enrolling Children Into Traumatic Brain Injury Trials: An Observational Study

Academic-community partnerships improve outcomes in pediatric trauma care

Accuracy of physician-estimated probability of brain injury in children with minor head trauma

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