Utility of Emergency Department Observation Units for Neurologically Intact Children With Head CT Abnormalities Secondary to Acute Closed Head Injury

Lefort, Roxanna; Hunter, Jill V.; Cruz, Andrea T.; Caviness, A. Chantal; Luerssen, Thomas G.; Adekunle-Ojo, Aderonke O.

doi:10.1097/pec.0000000000000863

Cited by 4 publications

(5 citation statements)

References 9 publications

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“…These findings are consistent with prior studies that emphasize that the pathology revealed on head CT must be interpreted within the clinical picture of the patient when determining the duration or level of hospitalization. 3,23,44 Certain constellations of imaging features, GCS scores, and neurological statuses had a particularly strong relationship with potentially unavoidable transfers. We noted that 29 patients were transferred with negative imaging and a GCS score of 15, with no reported seizures or loss of consciousness.…”

Section: Discussionmentioning

confidence: 99%

Secondary overtriage of pediatric neurosurgical trauma at a Level I pediatric trauma center

Mackel

Morel

Winer

et al. 2018

Journal of Neurosurgery: Pediatrics

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OBJECTIVEThe authors reviewed the transfer requests for isolated pediatric traumatic brain injuries (TBIs) at a Level I/II facility with the goal of identifying clinical and radiographic traits associated with potentially avoidable transfers that could be safely managed in a non–tertiary care setting.METHODSThe authors conducted a retrospective study of patients < 18 years of age classified as having TBI and transferred to their Level I tertiary care center over a 12-year period. The primary outcome of interest was identifying potentially avoidable transfers, defined as transfers of patients not requiring any neurosurgical intervention and discharged 1 hospital day after admission.RESULTSOverall, 70.8% of pediatric patients with isolated TBI did not require neurosurgical intervention or monitoring, indicating an avoidable transfer. Potentially avoidable transfers were associated with outside hospital imaging that was negative (86%) or showed isolated, nondisplaced skull fractures (86%) compared to patients with cranial pathology (53.8%, p < 0.001) as well as age ≤ 6 years (81% [negative imaging/isolated, nondisplaced fractures] vs 54% [positive cranial pathology], p < 0.001). The presence of headaches, nonfocal deficits, and loss of consciousness were associated with necessary transfer (p < 0.05). Patients with potentially avoidable transfers underwent frequent repeat CT studies (19.1%) and admissions to the pediatric intensive care unit (55.9%) but at a lower rate than those whose transfers were necessary (p < 0.001). Neurosurgical interventions occurred in 11% of patients with cranial pathology, which accounted for 17.9% of necessary transfers and 5.2% of all transfers.CONCLUSIONSIn the authors’ region, potentially up to 70% of interfacility transfers for pediatric brain trauma in the absence of other systemic injuries warranting surgical intervention may not require neurosurgical intervention and could be managed locally. No patients transferred with isolated, nondisplaced skull fractures or negative CT scans required neurosurgical intervention, and 86% were discharged the day after admission. In contrast, 11% of patients with CT scans indicative of cranial pathology required neurosurgical intervention. Age > 6 years, loss of consciousness, and nonfocal deficits were associated with a greater likelihood of needing a transfer. Further studies are required to clarify which patients can be managed at local institutions, but referring centers should practice overcaution given the potential risks.

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Section: Discussionmentioning

confidence: 99%

Secondary overtriage of pediatric neurosurgical trauma at a Level I pediatric trauma center

Mackel

Morel

Winer

et al. 2018

Journal of Neurosurgery: Pediatrics

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“…소아청소년과 전공의 수련이 단층촬영 빈도에 미치는 영향에 관해서는 아직 논란이 있다 20,22,23) . 202명 중 3명(1.5%)의 추적 단층촬영에서 새로운 병소가 발견됐고, 수술이 필요한 환자는 없었다 24) . 수술 필요성 예측에 있어서, 신경학적 악화를 확인하는 것이 일상적인 추적 단층촬영보다 정확하다 [24][25][26][27][28][29] .…”

Section: 의사의 경험unclassified

“…202명 중 3명(1.5%)의 추적 단층촬영에서 새로운 병소가 발견됐고, 수술이 필요한 환자는 없었다 24) . 수술 필요성 예측에 있어서, 신경학적 악화를 확인하는 것이 일상적인 추적 단층촬영보다 정확하다 [24][25][26][27][28][29] . 따라서 응급실 방문 당 시 또는 이후 증상이 악화한 환자가 단층촬영이 필요하다 (Fig.…”

Section: 의사의 경험unclassified

“…중간위험군 위험도층화 6) [24][25][26][27][28][29] . 게다가, 나중 에 수술이 필요하다고 밝혀진 환자는 응 급실 방문 당시 글래스고혼수척도 8 이 하(PECARN 규칙의 대상이 아님)이거 나 신경학적으로 악화하는 경향을 보였 다 24,[26][27][28] .…”

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“…중간위험군 위험도층화 6) [24][25][26][27][28][29] . 게다가, 나중 에 수술이 필요하다고 밝혀진 환자는 응 급실 방문 당시 글래스고혼수척도 8 이 하(PECARN 규칙의 대상이 아님)이거 나 신경학적으로 악화하는 경향을 보였 다 24,[26][27][28] . 최근 발표된 체계적문헌연구 에 따르면, 선형 두개골골절 단독 환자 6,358명 중 0.1%의 추적 단층촬영에서 새 병소를 발견했고, 나중에 수술이 필 요한 환자는 없었다 45) .…”

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Risk stratification of intermediate-risk children with minor head injury: a secondary publication translated into Korean

Kim¹

2022

Pediatr Emerg Med J

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The Pediatric Emergency Care Applied Research Network rule helps emergency physicians identify very low-risk children with minor head injury who can forgo head computed tomography. This rule contributes to reducing lifetime risk of radiation-induced cancers while minimizing missing clinically important traumatic brain injury. However, in intermediate-risk children, decisions on whether to perform computed tomography remain at the emergency physicians' discretion. To reduce this gray zone, this review summarizes evidence for risk stratification of intermediate-risk children with minor head injury.

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Head CT findings and deterioration risk in children with head injuries and Glasgow Coma Scales of 15

Mizu

Matsuoka

Huh

et al. 2021

The American Journal of Emergency Medicine

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Utility of Emergency Department Observation Units for Neurologically Intact Children With Head CT Abnormalities Secondary to Acute Closed Head Injury

Cited by 4 publications

References 9 publications

Secondary overtriage of pediatric neurosurgical trauma at a Level I pediatric trauma center

Secondary overtriage of pediatric neurosurgical trauma at a Level I pediatric trauma center

Risk stratification of intermediate-risk children with minor head injury: a secondary publication translated into Korean

Head CT findings and deterioration risk in children with head injuries and Glasgow Coma Scales of 15

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