Pediatric head injuries: Can clinical factors reliably predict an abnormality on computed tomography?

Dietrich, Ann; Bowman, Mary Jo; Ginn‐Pease, Margaret E.; Kosnik, Edward J.; King, Denis R.

doi:10.1016/s0196-0644(05)81254-5

Cited by 145 publications

(127 citation statements)

References 11 publications

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“…Rivara et al 20 retrospectively studied 98 children, and described an abnormal Glasgow Coma Scale (GCS) score, altered consciousness, and focal neurologic abnormality as predictors of intracranial injury. Dietrich et al 15 and Ramundo et al 16 prospectively studied children who underwent head CT for evaluation of head injury after presentation to the emergency department. Dietrich et al 15 reported loss of consciousness, amnesia, GCS score less than 15, and neurologic deficit as significant associations with intracranial injury.…”

Section: Discussionmentioning

confidence: 99%

“…Dietrich et al 15 and Ramundo et al 16 prospectively studied children who underwent head CT for evaluation of head injury after presentation to the emergency department. Dietrich et al 15 reported loss of consciousness, amnesia, GCS score less than 15, and neurologic deficit as significant associations with intracranial injury. Ramundo et al 16 described suspicion of child abuse, focal motor deficit, and pupillary asymmetry as predictors of intracranial injury.…”

Section: Discussionmentioning

confidence: 99%

“…These prospective studies have examined the value of imaging in a series of patients selected for head CT on the basis of unspecified criteria. 15,16 The purpose of this study was to evaluate clinical features associated with head injury that impact the decision to obtain imaging studies using prospective data collection and predetermined selection criteria.…”

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confidence: 99%

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Diagnostic Testing for Acute Head Injury in Children: When Are Head Computed Tomography and Skull Radiographs Indicated?

et al. 1997

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ABSTRACT. Objective. Despite the frequent occurrence of head injury in children, there is no agreement about clinical screening criteria that indicate the need for imaging studies. This study was undertaken to provide information relevant to the choice of imaging modalities in children with acute head trauma.Methodology. A prospective cohort of 322 children seeking care consecutively in an urban pediatric emergency department for nontrivial head injury was assembled. Skull radiographs, head computed tomography, and data forms including mechanism of injury, symptoms, and physical findings were completed for each child.Results. Intracranial injury occurred in 27 children (8%), whereas 50 (16%) had skull fractures. Of those with intracranial injury, 16 (59%) had normal mental status and no focal abnormalities, and 1 of those 16 required surgery for evacuation of an epidural hematoma. Six (38%) of the 16 were younger than 1 year, 5 of whom had scalp contusion or hematoma without other symptoms. Findings not significantly associated with intracranial injury were scalp contusion, laceration, hematoma, abrasion, headache, vomiting, seizure, drowsiness, amnesia, and loss of consciousness for less than 5 minutes. Findings associated with intracranial injury were skull fracture, signs of a basilar skull fracture, loss of consciousness for more than 5 minutes, altered mental status, and focal neurologic abnormality.Conclusions. Intracranial injury may occur with few or subtle signs and symptoms, especially in infants younger than 1 year. The relative risk for intracranial injury is increased almost fourfold in the presence of a skull fracture, although the absence of a skull fracture does not rule out intracranial injury. The significance of nonsurgical intracranial injury in neurologically normal children needs further study. Pediatrics 1997;99(5). URL: http://www.pediatrics.org/cgi/content/full/99/5/e11; brain injuries, head injuries, skull fractures, computed tomography, radiography.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Diagnostic Testing for Acute Head Injury in Children: When Are Head Computed Tomography and Skull Radiographs Indicated?

et al. 1997

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“…Two studies indicated that among patients with a GCS score of 15, normal neurologic examinations, no history of loss of consciousness or amnesia, no vomiting, headache, or subtle changes in mental status, there were no abnormal CT scan findings. 1,7 One additional case series (49 children) found that no child with a GCS of 15, a completely normal neurologic examination, and no trauma aside from the head injury experienced an intracranial lesion, even with a history of loss of consciousness or amnesia. 9 The upper limits for the 95% confidene interval for this estimate is 6%, and the analysis that identified this group of predictors is exploratory; no confirmatory analyses were undertaken in a second dataset.…”

Section: Risk Of Intracranial Injurymentioning

confidence: 99%

Technical Report: Minor Head Injury in Children

Homer¹,

Kleinman²

1999

Pediatrics

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ABSTRACT. Minor head trauma affecting children is a common reason for medical consultation and evaluation. In order to provide evidence on which to base a clinical practice guideline for the American Academy of Pediatrics, we undertook a systematic review of the literature on minor head trauma in children.Methods. Medline and Health databases were searched for articles published between 1966 and 1993 on head trauma or head injury, limited to infants, children, and adolescents. Abstracts were reviewed for relevance to mild head trauma consistent with the index case defined by the AAP subcommittee. Relevant articles were identified, reviewed, and abstracted. Additional citations were identified by review of references and expert suggestions. Unpublished data were also identified through contact with authors highlighting child-specific information. Abstracted data were summarized in evidence tables. The process was repeated in 1998, updating the review for articles published between 1993 and 1997.Results. A total of 108 articles were abstracted from 1033 abstracts and articles identified through the various search strategies. Variation in definitions precluded any pooling of data from different studies. Prevalence of intracranial injury in children with mild head trauma varied from 0% to 7%. Children with no clinical risk characteristics are at lower risk than are children with such characteristics; the magnitude of increased risk was inconsistent across studies. Computed tomography scan is most sensitive and specific for detection of intracranial abnormalities; sensitivity and specificity of skull radiographs ranged from 21% to 100% and 53% to 97%, respectively. No high quality studies tested alternative strategies for management of such children. Outcome studies are inconclusive as to the impact of minor head trauma on long-term cognitive function.Conclusions. The literature on mild head trauma does not provide a sufficient scientific basis for evidencebased recommendations about most of the key issues in clinical management. More consistent definitions and multisite assessments are needed to clarify this field. Pediatrics 1999;104(6). URL: http://www.pediatrics.org/ cgi/content/full/104/6/e78; head trauma, imaging, literature review.ABBREVIATIONS. CT, computed tomography; MRI, magnetic resonance imaging; GCS, Glasgow coma scale. Minor head trauma affecting a child is a common reason for medical consultation and evaluation. No consensus exists concerning the appropriate diagnostic assessment of such children. Previous surveys of physicians indicated significant variation in practice, and examination of hospitalization rates shows substantial regional variation for this condition. The American Academy of Pediatrics, in coordination with the American Academy of Family Physicians, launched an initiative to develop a clinical practice guideline to reduce variation and improve the quality of care of children with minor head trauma.This report provides the technical information on the literature concerning minor head t...

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“…About 3 to 6% of children suffering from minor head trauma will have intracranial injury. [4][5][6][7][8][9][10] In a systematic review by Maguire and colleagues, the need for neurosurgical intervention in children with minor head trauma varied from 0.2 to 0.6%. 11 These observations underline the importance of reliable features to identify children at risk for such complications.…”

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confidence: 99%

Variation in the use of skull radiographs by emergency physicians in young children with minor head trauma

Carrière

Clément

Gravel

2014

CJEM

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Background: Minor head trauma in young children is a major cause of emergency department visits. Conflicting guidelines exist regarding radiologic evaluation in such cases. Objective: To determine the practice pattern among Canadian emergency physicians for ordering skull radiographs in young children suffering from minor head trauma. Physicians were also surveyed on their willingness to use a clinical decision rule in such cases. Design/Methods: A self-administered email questionnaire was sent to all members of the Pediatric Emergency Research Canada (PERC) group. It consisted of clinical vignettes followed by multiple-option answers on the management plan. The study was conducted using the principles of the Dillman Tailored Design method and included multiple emailings to maximize the response rate. The research protocol received Institutional Review Board approval. Results: A total of 158 of 295 (54%) PERC members responded. Most participants were trained in pediatric emergency medicine and assessed more than 500 children per year. Imaging management for the vignettes was highly variable: 6 of the 11 case scenarios had a proportion of radiograph ordering between 20 and 80%. Ninety-five percent of respondents stated that they would apply a validated clinical decision rule for the detection of skull fracture in young children with minor head trauma. The minimum sensitivity deemed acceptable for such a rule was 98%. Conclusion: Canadian emergency physicians have a wide variation in skull radiography ordering in young children with minor head trauma. This variation, along with the need expressed by physicians, suggests that further research to develop a clinical decision rule is warranted.

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Pediatric head injuries: Can clinical factors reliably predict an abnormality on computed tomography?

Cited by 145 publications

References 11 publications

Diagnostic Testing for Acute Head Injury in Children: When Are Head Computed Tomography and Skull Radiographs Indicated?

Diagnostic Testing for Acute Head Injury in Children: When Are Head Computed Tomography and Skull Radiographs Indicated?

Technical Report: Minor Head Injury in Children

Variation in the use of skull radiographs by emergency physicians in young children with minor head trauma

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