Traumatic brain injury in young children with isolated scalp haematoma

Bressan, Silvia; Kochar, Amit; Oakley, Ed; Borland, Meredith L; Phillips, Natalie; Dalton, Sarah; Lyttle, Mark D; Hearps, Stephen; Cheek, John A; Furyk, Jeremy; Neutze, Jocelyn; Dalziel, Stuart R; Babl, Franz E

doi:10.1136/archdischild-2018-316066

Cited by 6 publications

(4 citation statements)

References 31 publications

(52 reference statements)

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“…Of the three children <2 years with ciTBI in the intermediate‐risk category, two had an isolated non–frontal scalp hematoma and one had both a scalp hematoma and did not act normally according to parents. Previous secondary analyses of the PECARN and APHIRST original data set have provided detailed risk estimates of ciTBI for each intermediate‐risk predictor in isolation (meaning no other signs or symptoms of ciTBI), namely, vomiting, loss of consciousness, scalp hematoma, severe mechanism of injury, severe headache, and child not acting normally as per guardian; in isolation they were associated with a very low risk of ciTBI of less than 1% 16,19–25 . Our study adds to this literature by providing ciTBI risk estimates for different combinations of predictors within the PECARN high‐ and intermediate‐risk groups.…”

Section: Discussionmentioning

confidence: 82%

PECARN algorithms for minor head trauma: Risk stratification estimates from a prospective PREDICT cohort study

Bressan

Eapen

Phillips

et al. 2021

Academic Emergency Medicine

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Background The Pediatric Emergency Care Applied Research Network (PECARN) head trauma clinical decision rules informed the development of algorithms that risk stratify the management of children based on their risk of clinically important traumatic brain injury (ciTBI). We aimed to determine the rate of ciTBI for each PECARN algorithm risk group in an external cohort of patients and that of ciTBI associated with different combinations of high‐ or intermediate‐risk predictors. Methods This study was a secondary analysis of a large multicenter prospective data set, including patients with Glasgow Coma Scale scores of 14 or 15 conducted in Australia and New Zealand. We calculated ciTBI rates with 95% confidence intervals (CIs) for each PECARN risk category and combinations of related predictor variables. Results Of the 15,163 included children, 4,011 (25.5%) were aged <2 years. The frequency of ciTBI was 8.5% (95% CI = 6.0%–11.6%), 0.2% (95% CI = 0.0%–0.6%), and 0.0% (95% CI = 0.0%–0.2%) in the high‐, intermediate‐, and very‐low‐risk groups, respectively, for children <2 years and 5.7% (95% CI = 4.4%–7.2%), 0.7% (95% CI = 0.5%–1.0%), and 0.0% (95% CI = 0.0%–0.1%) in older children. The isolated high‐risk predictor with the highest risk of ciTBI was “signs of palpable skull fracture” for younger children (11.4%, 95% CI = 5.3%–20.5%) and “signs of basilar skull fracture” in children ≥2 years (11.1%, 95% CI = 3.7%–24.1%). For older children in the intermediate‐risk category, the presence of all four predictors had the highest risk of ciTBI (25.0%, 95% CI = 0.6%–80.6%) followed by the combination of “severe mechanism of injury” and “severe headache” (7.7%, 95% CI = 0.2%–36.0%). The very few children <2 years at intermediate risk with ciTBI precluded further analysis. Conclusions The risk estimates of ciTBI for each of the PECARN algorithms risk group were consistent with the original PECARN study. The risk estimates of ciTBI within the high‐ and intermediate‐risk predictors will help further refine clinical judgment and decision making on neuroimaging.

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Section: Discussionmentioning

confidence: 82%

PECARN algorithms for minor head trauma: Risk stratification estimates from a prospective PREDICT cohort study

Bressan

Eapen

Phillips

et al. 2021

Academic Emergency Medicine

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“…6 A more recent study compared PECARN and CHA-LICE prediction rules for risk of ciTBI/TBI in infants with ISH using a large prospective cohort of head-injured children enrolled in EDs located in Australia and New Zealand. 11 Using the PECARN rule the risk of ciTBI in infants younger than 1 year with ISH was 0% (95% CI = 0.3% to 3.3%), compared with 20% (95% CI = 8.4% to 36.9) using the CHALICE prediction rule. However, for the PECARN analysis the numbers were low (109 infants) and 12.5% had TBI on CT. Additionally, only overall risk for ciTBI and TBI on CT were reported without more granular analysis of specific predictors.…”

Section: Discussionmentioning

confidence: 93%

“…In a secondary analysis of the PECARN TBI study of children < 2 years of age with an ISH, younger age, nonfrontal location and larger hematoma size location as well as mechanism of injury were each associated with higher risk of TBI; however, each predictor in isolation gives limited guidance regarding an individual infant’s specific risk 6 . A more recent study compared PECARN and CHALICE prediction rules for risk of ciTBI/TBI in infants with ISH using a large prospective cohort of head‐injured children enrolled in EDs located in Australia and New Zealand 11 . Using the PECARN rule the risk of ciTBI in infants younger than 1 year with ISH was 0% (95% CI = 0.3% to 3.3%), compared with 20% (95% CI = 8.4% to 36.9) using the CHALICE prediction rule.…”

Section: Discussionmentioning

confidence: 99%

The Infant Scalp Score: A Validated Tool to Stratify Risk of Traumatic Brain Injury in Infants With Isolated Scalp Hematoma

Schutzman

Nigrovic

Mannix

2020

Academic Emergency Medicine

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Objectives The objective was to validate the previously derived Infant Scalp Score (ISS) that uses clinical signs in infants with isolated scalp hematoma (ISH) after head trauma to stratify risk for clinically important traumatic brain injury (ciTBI) or TBI on computed tomography (CT). Methods Using the publicly available Pediatric Emergency Care Applied Research Network TBI data set, we selected infants ≤ 1 year with GCS 14 to 15 who had ISH (defined as hematoma without other signs/symptoms of TBI). CT scans were obtained at the treating physician’s discretion. We calculated ISS based on age, hematoma size, and location (range = 0–8) for each patient and calculated the sensitivity and specificity of the score for ciTBI and TBI on CT across a range of ISS cut‐points. Results We included 1,289 infants ≤ 1 year of whom 462 (36%) had CT performed. Twelve had ciTBI and 59 had TBI on CT. An ISS cutoff ≥ 4 had sensitivity of 100% for ciTBI (95% confidence interval [CI] = 0.74 to 1.0) and TBI with specificity of 0.49 (95% CI = 0.46 to 0.51). An ISS cutoff of ≥5 had a sensitivity of 100% for ciTBI (95% CI = 0.74 to 1.0) and specificity of 0.68 (95% CI = 0.66 to 0.71), but missed three infants with TBI on CT (none of whom required intervention). The receiver operating characteristic curves for clinical score to detect ciTBI and TBI had areas under the curve of 0.916 and 0.807, respectively. Conclusions The ISS accurately stratified risk for ciTBI and TBI on CT in infants with ISH and is a useful tool to help guide clinical decision making.

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“…6,8,12,13 The degree to which these data apply to infants <3 months old is unclear; however, prior studies suggest that younger infants with isolated small scalp hematomas are at higher risk of traumatic brain injury on CT compared to older infants and children. 6,21,31,32 One study demonstrated that among infants younger than 2 years with isolated scalp hematomas, clinically important traumatic brain injuries occurred in 2.2% of those <3 months old, compared to 0.3% of children between 3 and 24 months old. 6 In conclusion, the PECARN traumatic brain injury lowrisk criteria accurately identified infants younger than 3 months at low risk of clinically important traumatic brain injuries.…”

Section: Discussionmentioning

confidence: 99%

Risk of Traumatic Brain Injuries in Infants Younger than 3 Months With Minor Blunt Head Trauma

Abid

Kuppermann

Tancredi

et al. 2021

Annals of Emergency Medicine

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Study objective: Infants with head trauma often have subtle findings suggestive of traumatic brain injury. Prediction rules for traumatic brain injury among children with minor head trauma have not been specifically evaluated in infants younger than 3 months old. We aimed to determine the risk of clinically important traumatic brain injuries, traumatic brain injuries on computed tomography (CT) images, and skull fractures in infants younger than 3 months of age who did and did not meet the age-specific Pediatric Emergency Care Applied Research Network (PECARN) low-risk criteria for children with minor blunt head trauma.Methods: We conducted a secondary analysis of infants <3 months old in the public use data set from PECARN's prospective observational study of children with minor blunt head trauma. Main outcomes included (1) clinically important traumatic brain injury, (2) traumatic brain injury on CT, and (3) skull fracture on CT.Results: Of 10,904 patients <2 years old, 1,081 (9.9%) with complete data were <3 months old; most (750/1081, 69.6%) sustained falls, and 633/1081 (58.6%) underwent CT scans. Of the 514/1081 (47.5%) infants who met the PECARN low-risk criteria, 1/514 (0.2%, 95% confidence interval [CI] 0.005% to 1.1%), 10/197 (5.1%, 2.5% to 9.1%), and 9/197 (4.6%, 2.1% to 8.5%) had clinically important traumatic brain injuries, traumatic brain injuries on CT, and skull fractures, respectively. Of 567 infants who did not meet the low-risk PECARN criteria, 24/567 (4.2%, 95% CI 2.7% to 6.2%), 94/436 (21.3%, 95% CI 17.6% to 25.5%), and 122/436 (28.0%, 95% CI 23.8% to 32.5%) had clinically important traumatic brain injuries, traumatic brain injuries, and skull fractures, respectively. Conclusion:The PECARN traumatic brain injury low-risk criteria accurately identified infants <3 months old at low risk of clinically important traumatic brain injuries. However, infants at low risk for clinically important traumatic brain injuries remained at risk for traumatic brain injuries on CT, suggesting the need for a cautious approach in these infants. [

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Traumatic brain injury in young children with isolated scalp haematoma

Cited by 6 publications

References 31 publications

PECARN algorithms for minor head trauma: Risk stratification estimates from a prospective PREDICT cohort study

PECARN algorithms for minor head trauma: Risk stratification estimates from a prospective PREDICT cohort study

The Infant Scalp Score: A Validated Tool to Stratify Risk of Traumatic Brain Injury in Infants With Isolated Scalp Hematoma

Risk of Traumatic Brain Injuries in Infants Younger than 3 Months With Minor Blunt Head Trauma

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