Validation and refinement of a clinical decision rule for the use of computed tomography in children with minor head injury in the emergency department

Osmond, Martin H.; Klassen, Terry P.; Wells, George A.; Davidson, Jennifer; Correll, Rhonda; Boutis, Kathy; Joubert, Gary; Gouin, Serge; Khangura, Simi; Turner, Troy; Bélanger, F.; Silver, Norm; Taylor, Brett; Curran, Janet; Stiell, Ian G.

doi:10.1503/cmaj.170406

Cited by 29 publications

(37 citation statements)

References 34 publications

(25 reference statements)

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“…For example, the incidence rate of probable rCDE in the current study was 4%-5% for patients with pmTBI that were consecutively recruited from ED settings, which is similar to rates observed in recent large-scale CT studies. 3,4 Previous ED-based studies have reported much higher incidence rates of positive MRI findings (e.g., 17.6% 39 ; 52% 40 ), though the severity of injury and premorbid risk factors in those studies may not be comparable to the current study. In contrast, sport-related concussion samples have reported much lower incidence rates (e.g., 0.5% 19 ).…”

Section: Discussioncontrasting

confidence: 71%

“…Mild traumatic brain injury (mTBI) presents with disparate clinical and radiologic characteristics. 1,2 CT remains the de facto imaging modality for acute mTBI, 3,4 but both firstgeneration (T1-/T2-weighted) and more advanced MRI structural scans (e.g., susceptibility-weighted imaging [SWI], fluid-attenuated inversion recovery [FLAIR] or T2*-weighted sequences) reportedly detect lesions in an additional 25%-30% of patients, and provide unique diagnostic and prognostic information. 5,6 Radiologic common data elements (rCDE; table 1) were developed via consensus expert panels to cover the spectrum of TBI severity 7 or more specifically for sport-related concussion.…”

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confidence: 99%

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Radiologic common data elements rates in pediatric mild traumatic brain injury

et al. 2020

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ObjectiveThe nosology for classifying structural MRI findings following pediatric mild traumatic brain injury (pmTBI) remains actively debated. Radiologic common data elements (rCDE) were developed to standardize reporting in research settings. However, some rCDE are more specific to trauma (probable rCDE). Other more recently proposed rCDE have multiple etiologies (possible rCDE), and may therefore be more common in all children. Independent cohorts of patients with pmTBI and controls were therefore recruited from multiple sites (New Mexico and Ohio) to test the dual hypothesis of a higher incidence of probable rCDE (pmTBI > controls) vs similar rates of possible rCDE on structural MRI.MethodsPatients with subacute pmTBI (n = 287), matched healthy controls (HC; n = 106), and orthopedically injured (OI; n = 71) patients underwent imaging approximately 1 week postinjury and were followed for 3–4 months.ResultsProbable rCDE were specific to pmTBI, occurring in 4%–5% of each sample, rates consistent with previous large-scale CT studies. In contrast, prevalence rates for incidental findings and possible rCDE were similar across groups (pmTBI vs OI vs HC). The prevalence of possible rCDE was also the only finding that varied as a function of site. Possible rCDE and incidental findings were not associated with postconcussive symptomatology or quality of life 3–4 months postinjury.ConclusionCollectively, current findings question the trauma-related specificity of certain rCDE, as well how these rCDE are radiologically interpreted. Refinement of rCDE in the context of pmTBI may be warranted, especially as diagnostic schema are evolving to stratify patients with structural MRI abnormalities as having a moderate injury.

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Section: Discussioncontrasting

confidence: 71%

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confidence: 99%

Radiologic common data elements rates in pediatric mild traumatic brain injury

et al. 2020

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“…The rate of CCT scanning in children with head trauma range from 1/3 to 1/2 [6,[14][15][16]. This rate was reported as 35.2% in the study of Kuppermann et al, 52.8% and 34.9% in the studies by Osmond et al conducted in 2010 and2018, respectively, 30.4% in the study of Kemp et al, 62% in the study of Palchak et al,and 88.2% in the study of Andrade et al [5,6,8,14,16,17]. In our study, CCT imaging was performed in 69.6% of the patients.…”

Section: Discussionmentioning

confidence: 99%

Effect of parental pressure on emergency physicians for computerized tomography imaging request in children with head trauma

Boğan

Sabak²,

Oktay

et al. 2021

The American Journal of Emergency Medicine

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Background: Both minor and major head traumas constitute an important proportion of childhood emergency admissions. In this study, the findings of cranial computed tomography (CCT) scans performed as a result of the parental pressure were evaluated. Methods: The frequency and findings of CCT scans performed as a result of parental pressure were examined in a separate subgroup. Results: A total of 227 patients were included in the study; 158 (69.9%) patients had undergone CCT scans; a pathological finding was detected in 24 (10.6%) of these patients and undergone a consultation by the neurosurgeon (most common finding was isolated linear fracture; n = 12; 50%). The patients undergoing CCT scans were divided in two subgroups: the PECARN group [n = 123 (77.8%)] and the Parental pressure group [n = 33 (22.2%)]. Conclusion: One third of the parents of children who presented to the emergency department with head trauma and had no indication for CCT according to PECARN rules insisted on CCT imaging, and none of these cases showed ciTBI, surgical operation, or mortality. None of the patients in the parental pressure group had a history of surgical intervention or mortality within one month after discharge.

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“…In 2010 a multicentre cohort study from Canada also addressed this matter and developed a decision rule for CT use in children with minor head injury – Canadian Assessment of Tomography for Childhood Head injury (CATCH) [ 13 ]. A revision of the CATCH guidelines, CATCH2, was published in 2018 [ 14 ].…”

Section: Introductionmentioning

confidence: 99%

“…These three decision rules—CHALICE, PECARN and CATCH, have been validated and shown to have high sensitivity [ 14 , 15 ].…”

Section: Introductionmentioning

confidence: 99%

Validation of the scandinavian guidelines for initial management of minor and moderate head trauma in children

Sönnerqvist

Brus

Olivecrona

2020

Eur J Trauma Emerg Surg

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Background Head trauma in children is common, with a low rate of clinically important traumatic brain injury. CT scan is the reference standard for diagnosis of traumatic brain injury, of which the increasing use is alarming because of the risk of induction of lethal malignancies. Recently, the Scandinavian Neurotrauma Committee derived new guidelines for the initial management of minor and moderate head trauma. Our aim was to validate these guidelines. Methods We applied the guidelines to a population consisting of children with mild and moderate head trauma, enrolled in the study: "Identification of children at very low risk of clinically-important brain injuries after head trauma: a prospective cohort study" by Kuppermann et al.

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Validation and refinement of a clinical decision rule for the use of computed tomography in children with minor head injury in the emergency department

Cited by 29 publications

References 34 publications

Radiologic common data elements rates in pediatric mild traumatic brain injury

Radiologic common data elements rates in pediatric mild traumatic brain injury

Effect of parental pressure on emergency physicians for computerized tomography imaging request in children with head trauma

Validation of the scandinavian guidelines for initial management of minor and moderate head trauma in children

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