1
|
Khalili H, Rismani M, Nematollahi MA, Masoudi MS, Asadollahi A, Taheri R, Pourmontaseri H, Valibeygi A, Roshanzamir M, Alizadehsani R, Niakan A, Andishgar A, Islam SMS, Acharya UR. Prognosis prediction in traumatic brain injury patients using machine learning algorithms. Sci Rep 2023; 13:960. [PMID: 36653412 PMCID: PMC9849475 DOI: 10.1038/s41598-023-28188-w] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 01/13/2023] [Indexed: 01/19/2023] Open
Abstract
Predicting treatment outcomes in traumatic brain injury (TBI) patients is challenging worldwide. The present study aimed to achieve the most accurate machine learning (ML) algorithms to predict the outcomes of TBI treatment by evaluating demographic features, laboratory data, imaging indices, and clinical features. We used data from 3347 patients admitted to a tertiary trauma centre in Iran from 2016 to 2021. After the exclusion of incomplete data, 1653 patients remained. We used ML algorithms such as random forest (RF) and decision tree (DT) with ten-fold cross-validation to develop the best prediction model. Our findings reveal that among different variables included in this study, the motor component of the Glasgow coma scale, the condition of pupils, and the condition of cisterns were the most reliable features for predicting in-hospital mortality, while the patients' age takes the place of cisterns condition when considering the long-term survival of TBI patients. Also, we found that the RF algorithm is the best model to predict the short-term mortality of TBI patients. However, the generalized linear model (GLM) algorithm showed the best performance (with an accuracy rate of 82.03 ± 2.34) in predicting the long-term survival of patients. Our results showed that using appropriate markers and with further development, ML has the potential to predict TBI patients' survival in the short- and long-term.
Collapse
Affiliation(s)
- Hosseinali Khalili
- Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Department of Neurosurgery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Maziyar Rismani
- Student Research Committee, Fasa University of Medical Sciences, Fasa, Iran
| | | | - Mohammad Sadegh Masoudi
- Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Department of Neurosurgery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Arefeh Asadollahi
- Noncommunicable Diseases Research Center, Fasa University of Medical Sciences, Fasa, Iran
| | - Reza Taheri
- Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Department of Neurosurgery, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Hossein Pourmontaseri
- Student Research Committee, Fasa University of Medical Sciences, Fasa, Iran
- Bitab Knowledge Enterprise, Fasa University of Medical Sciences, Fasa, Iran
| | - Adib Valibeygi
- Student Research Committee, Fasa University of Medical Sciences, Fasa, Iran
| | - Mohamad Roshanzamir
- Department of Computer Engineering, Faculty of Engineering, Fasa University, Fasa, 74617-81189, Iran
| | - Roohallah Alizadehsani
- Institute for Intelligent Systems Research and Innovation (IISRI), Deakin University, Geelong, Australia
| | - Amin Niakan
- Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Department of Neurosurgery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Aref Andishgar
- Student Research Committee, Fasa University of Medical Sciences, Fasa, Iran
| | - Sheikh Mohammed Shariful Islam
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, Australia
- Cardiovascular Division, The George Institute for Global Health, Newtown, Australia
- Sydney Medical School, University of Sydney, Camperdown, Australia
| | - U Rajendra Acharya
- Department of Electronics and Computer Engineering, Ngee Ann Polytechnic, Singapore, Singapore
- Department of Biomedical Engineering, School of Science and Technology, Singapore University of Social Sciences, Singapore, Singapore
- Department of Bioinformatics and Medical Engineering, Asia University, Taichung City, Taiwan
| |
Collapse
|
2
|
Evaluation of Pediatric Patients Admitted to the Emergency Department with Head Trauma. JOURNAL OF CONTEMPORARY MEDICINE 2021. [DOI: 10.16899/jcm.914518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
3
|
Donnezan D, Delteil C, Moreau E, Bremond V, Boutin A, Bresson V, Tuchtan L, Piercecchi MD. Injuries from alleged accidental minor head trauma in a prospective cohort of children aged 0-3 years in an emergency department. Leg Med (Tokyo) 2021; 49:101846. [PMID: 33497971 DOI: 10.1016/j.legalmed.2021.101846] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 01/04/2021] [Accepted: 01/07/2021] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Minor head trauma in the child, whether accidental or inflicted, is a frequent reason for seeking medical attention. Our aim is to describe the characteristics of minor head trauma in children aged 0-3 years and the resulting injuries. This in order to help the clinician to suspect and thelegal expert to confirm intentional abuse. STUDY DESIGN Children aged from 0 to 3 years with minor head trauma and attending the pediatric emergency department were included in the study between January 2013 and June 2014. The correlation between the characteristics of trauma and the resulting injuries was analyzed using a prospective data collection questionnaire completed by the physicians who cared for the child. RESULTS A total of 709 children with minor head trauma were included in the study. In nearly 90% of cases, fall height was less than 1 m. Only one-third of children aged less than 6 months had external head injury. Low-intensity trauma, such as a low-velocity fall from a height of less than 1.5 m does not cause intracranial injury. External injuries were more frequent in children who had a fall with an anterior impact, while internal injuries were found only in posterior and lateral impacts. CONCLUSION In the context of minor head trauma, the physician must be vigilant and must ask for a full and clear description of the trauma, its mechanisms and other characteristics, when external or internal head injuries are observed in children aged less than 6 months.
Collapse
Affiliation(s)
- Diane Donnezan
- Department of Legal Medicine, Hôpital Saint Jean, Perpignan Hospital Center, Perpignan, France
| | - Clémence Delteil
- Department of Legal Medicine, Hôpital de la Timone, Marseille University Hospital Center, Marseille, France; Aix Marseille Univ, CNRS, EFS, ADES, Marseille, France.
| | - Emilie Moreau
- Pediatric Emergencies, Hôpital de la Timone, Marseille University Hospital Center, Marseille, France
| | - Valérie Bremond
- Pediatric Emergencies, Hôpital de la Timone, Marseille University Hospital Center, Marseille, France
| | - Aurélie Boutin
- Pediatric Emergencies, Hôpital de la Timone, Marseille University Hospital Center, Marseille, France
| | - Violaine Bresson
- Pediatric Emergencies, Hôpital de la Timone, Marseille University Hospital Center, Marseille, France
| | - Lucile Tuchtan
- Department of Legal Medicine, Hôpital de la Timone, Marseille University Hospital Center, Marseille, France; Aix Marseille Univ, CNRS, EFS, ADES, Marseille, France
| | - Marie-Dominique Piercecchi
- Department of Legal Medicine, Hôpital de la Timone, Marseille University Hospital Center, Marseille, France; Aix Marseille Univ, CNRS, EFS, ADES, Marseille, France
| |
Collapse
|
4
|
Bertsimas D, Dunn J, Steele DW, Trikalinos TA, Wang Y. Comparison of Machine Learning Optimal Classification Trees With the Pediatric Emergency Care Applied Research Network Head Trauma Decision Rules. JAMA Pediatr 2019; 173:648-656. [PMID: 31081856 PMCID: PMC6515573 DOI: 10.1001/jamapediatrics.2019.1068] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 01/29/2019] [Indexed: 02/04/2023]
Abstract
Importance Computed tomographic (CT) scanning is the standard for the rapid diagnosis of intracranial injury, but it is costly and exposes patients to ionizing radiation. The Pediatric Emergency Care Applied Research Network (PECARN) rules for identifying children with minor head trauma who are at very low risk of clinically important traumatic brain injury (ciTBI) are widely used to triage CT imaging. Objective To examine whether optimal classification trees (OCTs), which are novel machine-learning classifiers, improve on PECARN rules' predictive accuracy. Design, Setting, and Participants A secondary analysis of prospective, publicly available data on emergency department visits for head trauma used by the PECARN group to develop their tool was conducted to derive OCT-based prediction rules for ciTBI in a development cohort and compare their predictive performance vs the PECARN rules in a validation cohort among children who were younger than 2 years and 2 years or older. Data on 42 412 children with head trauma and without severely altered mental status who were examined between June 1, 2004, and September 30, 2006, were gathered from 25 emergency departments in North America participating in PECARN. Data analysis was conducted from September 15, 2016, to December 18, 2018. Main Outcomes and Measures The outcome was ciTBI, with predictive performance measured by estimating the sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, and negative likelihood ratio for the OCT and the PECARN rules. The OCT and PECARN rules' performance was compared by estimating ratios for each measure. Results Of the 42 412 children (15 996 [37.7%] girls) included in the analysis, 10 718 were younger than 2 years (25.3%; mean [SD] age, 11.6 [0.6] months) and 31 694 were 2 years or older (74.7%; age, 9.1 [4.9] years). Compared with PECARN rules, OCTs misclassified 0 vs 1 child with ciTBI in the younger and 10 vs 9 children with ciTBI in the older cohort, and correctly identified more children with very low risk of ciTBI in the younger (7605 vs 5701) and older (20 594 vs 18 134) cohorts. In the validation cohorts, compared with the PECARN rules, the OCTs had statistically significantly better specificity (in the younger cohort: 69.3%; 95% CI, 67.4%-71.2% vs 52.8%; 95% CI, 50.8%-54.9%; in the older cohort: 65.6%; 95% CI, 64.5%-66.8% vs 57.6%; 95% CI, 56.4%-58.8%), positive predictive value (odds ratios, 1.54; 95% CI, 1.36-1.74 and 1.23; 95% CI, 1.17-1.30, in younger and older children, respectively), and positive likelihood ratio (risk ratios, 1.54; 95% CI, 1.36-1.74 and 1.23; 95% CI, 1.17-1.30, in younger and older children, respectively). There were no statistically significant differences in the sensitivity, negative predictive value, and negative likelihood ratio between the 2 sets of rules. Conclusions and Relevance If implemented, OCTs may help reduce the number of unnecessary CT scans, without missing more patients with ciTBI than the PECARN rules.
Collapse
Affiliation(s)
- Dimitris Bertsimas
- Operations Research Center, Massachusetts Institute of Technology, Cambridge
| | - Jack Dunn
- Operations Research Center, Massachusetts Institute of Technology, Cambridge
| | - Dale W. Steele
- Departments of Emergency Medicine and Pediatrics, Alpert Medical School, Brown University, Providence, Rhode Island
- Center for Evidence Synthesis in Health, Brown University School of Public Health, Providence, Rhode Island
| | - Thomas A. Trikalinos
- Center for Evidence Synthesis in Health, Brown University School of Public Health, Providence, Rhode Island
| | - Yuchen Wang
- Operations Research Center, Massachusetts Institute of Technology, Cambridge
| |
Collapse
|
5
|
Kauffman JD, Litz CN, Thiel SA, Nguyen ATH, Carey A, Danielson PD, Chandler NM. To Scan or Not to Scan: Overutilization of Computed Tomography for Minor Head Injury at a Pediatric Trauma Center. J Surg Res 2018; 232:164-170. [DOI: 10.1016/j.jss.2018.06.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 05/25/2018] [Accepted: 06/01/2018] [Indexed: 10/28/2022]
|
6
|
Bozan Ö, Aksel G, Kahraman HA, Giritli Ö, Eroğlu SE. Comparison of PECARN and CATCH clinical decision rules in children with minor blunt head trauma. Eur J Trauma Emerg Surg 2017; 45:849-855. [DOI: 10.1007/s00068-017-0865-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 10/16/2017] [Indexed: 11/30/2022]
|
7
|
Masoumi B, Heydari F, Hatamabadi H, Azizkhani R, Yoosefian Z, Zamani M. The Relationship between Risk Factors of Head Trauma with CT Scan Findings in Children with Minor Head Trauma Admitted to Hospital. Open Access Maced J Med Sci 2017; 5:319-323. [PMID: 28698750 PMCID: PMC5503730 DOI: 10.3889/oamjms.2017.071] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Revised: 03/22/2017] [Accepted: 04/18/2017] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND: In emergency medicine for determining the intracranial injury (ICI) in children with head trauma, usually brain CT scan is performed. Since brain CT scan, especially in children, has some disadvantages, it is better to find a procedure which could help to choose only the children with real head trauma injury for brain CT scan. AIMS: The aim of this study is to find such procedure. This study was descriptive, analytic and non-interventional. METHODS: We reviewed the archived files of children with head trauma injuries referred to the emergency department of Imam Hossein Hospital within two years. Patient’s CT scan findings and head trauma risk factors were evaluated in this study. RESULTS: Out of 368 patients, 326 patients had normal brain CT scan. 28 of them showed symptoms of ICI consisting intraventricular haemorrhage (IVH), contusion, subarachnoid haemorrhage (SAH), subdural haemorrhage (SDH), epidural hematoma (EDH), and pneumocephalus. Twenty-seven patients showed skull FX, which 14 of them had an Isolated fracture, and 13 of them also showed symptoms of ICI. Since patients with isolated FX usually discharge quickly from Emergency Department; their data did not include in results of the study. The patients have been divided into two groups: 1- ICI, 2- without ICI. RR (relative risk), CI (Confidence interval) and sensitivity, positive predictive value (PPV), negative predictive value (NPV) and association of these risk factors with ICI were assessed with the Chi-2 test. In the end to determine the indications of CT scan, the presence of one of these five risk factors is important including abnormal mental status, clinical symptoms of skull FX, history of vomiting, craniofacial soft tissue injury (including subgaleal hematomas or laceration) and headache. CONCLUSIONS: For all other patients without these risk factors, observation and Follow Up can be used which has more advantages and less cost.
Collapse
Affiliation(s)
- Babak Masoumi
- Emergency Medicine Research Center, Department of Emergency Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Farhad Heydari
- Emergency Medicine Research Center, Department of Emergency Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hamidreza Hatamabadi
- Safety Promotion and Injury Prevention Research Center, Department of Emergency Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Reza Azizkhani
- Emergency Medicine Research Center, Department of Emergency Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Zahra Yoosefian
- Behavioral Sciences Research Center, Department of Psychiatry, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Majid Zamani
- Emergency Medicine Research Center, Department of Emergency Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| |
Collapse
|
8
|
Astrand R, Rosenlund C, Undén J. Scandinavian guidelines for initial management of minor and moderate head trauma in children. BMC Med 2016; 14:33. [PMID: 26888597 PMCID: PMC4758024 DOI: 10.1186/s12916-016-0574-x] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 02/02/2016] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND The management of minor and moderate head trauma in children differs widely between countries. Presently, there are no existing guidelines for management of these children in Scandinavia. The purpose of this study was to produce new evidence-based guidelines for the initial management of head trauma in the paediatric population in Scandinavia. The primary aim was to detect all children in need of neurosurgical intervention. Detection of any traumatic intracranial injury on CT scan was an important secondary aim. METHODS General methodology according to the Appraisal of Guidelines for Research and Evaluation (AGREE) II and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system was used. Systematic evidence-based review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology and based upon relevant clinical questions with respect to patient-important outcomes. Quality ratings of the included studies were performed using Quality Assessment of Diagnostic Accuracy Studies (QUADAS)-2 and Centre of Evidence Based Medicine (CEBM)-2 tools. Based upon the results, GRADE recommendations, a guideline, discharge instructions and in-hospital observation instructions were drafted. For elements with low evidence, a modified Delphi process was used for consensus, which included relevant clinical stakeholders. RESULTS The guidelines include criteria for selecting children for CT scans, in-hospital observation or early discharge, and suggestions for monitoring routines and discharge advice for children and guardians. The guidelines separate mild head trauma patients into high-, medium- and low-risk categories, favouring observation for mild, low-risk patients as an attempt to reduce CT scans in children. CONCLUSIONS We present new evidence and consensus based Scandinavian Neurotrauma Committee guidelines for initial management of minor and moderate head trauma in children. These guidelines should be validated before extensive clinical use and updated within four years due to rapid development of new diagnostic tools within paediatric neurotrauma.
Collapse
Affiliation(s)
- Ramona Astrand
- Department of Neurosurgery, Neurocenter 2091, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark.
| | - Christina Rosenlund
- Department of Neurosurgery, Odense University Hospital, Sdr. Boulevard 29, 5000, Odense C, Denmark
| | - Johan Undén
- Department of Intensive Care and Perioperative Medicine, Institute for Clinical Sciences, Skåne University Hospital, Södra Förstadsgatan 101, 20502, Malmö, Sweden.
| | | |
Collapse
|
9
|
Depressed skull fracture by a mass of 3kg in shot putt an adolescent of 13 years. A rare sports injury. A rare fracture of the skull-deflection shot putt. Int J Surg Case Rep 2014; 6C:203-5. [PMID: 25549954 PMCID: PMC4334875 DOI: 10.1016/j.ijscr.2014.10.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2014] [Accepted: 10/07/2014] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION More and more teenagers indulge in sports at school or in recreational settings. Some of these sports are considered to be purveyors of accidents and should be practiced by putting in place safety rules and regulations. This report is unusual case of a school child of age 13 who suffered from depressed skull fracture due to accidental fall of a mass of 3kg during an athletics meeting. PRESENTATION OF CASE He was a 13-year-old boy who accidentally received on his head a throwing mass of 3kg thrown by a young athlete at a school athletics meeting. He became unconsciousness for a moment. The radio clinical evaluation showed a parietal depressed fracture without mass effect on the brain parenchyma to the CT scan. Depression was surgically removed in quite favorable manner. DISCUSSION Karting is known as a particular sporting accident that causes head injuries affecting mostly children. Other sports such as boxing and skiing are also known to cause trauma but wearing helmets has significantly reduced these sports injuries. Throwing sports can also lead to accidents in the absence of strict security as demonstrated by this case. It was a skull depressed fracture that was operated upon because it entailed a risk leading to a compressive callus. CONCLUSION This accident could have been avoided if basic safety precautions were put in place.
Collapse
|
10
|
|
11
|
Dayan PS, Holmes JF, Atabaki S, Hoyle J, Tunik MG, Lichenstein R, Alpern E, Miskin M, Kuppermann N. Association of Traumatic Brain Injuries With Vomiting in Children With Blunt Head Trauma. Ann Emerg Med 2014; 63:657-65. [DOI: 10.1016/j.annemergmed.2014.01.009] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Revised: 12/24/2013] [Accepted: 01/08/2014] [Indexed: 11/30/2022]
|
12
|
Bahraini NH, Breshears RE, Hernández TD, Schneider AL, Forster JE, Brenner LA. Traumatic brain injury and posttraumatic stress disorder. Psychiatr Clin North Am 2014; 37:55-75. [PMID: 24529423 DOI: 10.1016/j.psc.2013.11.002] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Given the upsurge of research in posttraumatic stress disorder (PTSD) and traumatic brain injury (TBI), much of which has focused on military samples who served in Iraq and Afghanistan, the purpose of this article is to review the literature published after September 11th, 2001 that addresses the epidemiology, pathophysiology, evaluation, and treatment of PTSD in the context of TBI.
Collapse
Affiliation(s)
- Nazanin H Bahraini
- Department of Veterans Affairs, Veteran Integrated Service Network (VISN) 19 Mental Illness Research Education and Clinical Center (MIRECC), 1055 Clermont Street, Denver, CO 80220, USA; Department of Psychiatry, School of Medicine, University of Colorado, 13001 East 17th Place, Aurora, CO 80045, USA.
| | - Ryan E Breshears
- Wellstar Health System, Psychological Services, 55 Whitcher Street, Suite 420, Marietta, GA 30060, USA; Department of Counseling and Human Development, University of Georgia, 402 Aderhold Hall, Athens, GA 30602, USA
| | - Theresa D Hernández
- Department of Veterans Affairs, Veteran Integrated Service Network (VISN) 19 Mental Illness Research Education and Clinical Center (MIRECC), 1055 Clermont Street, Denver, CO 80220, USA; Department of Psychology and Neuroscience, University of Colorado, 1905 Colorado Avenue, Boulder, CO 80309, USA
| | - Alexandra L Schneider
- Department of Veterans Affairs, Veteran Integrated Service Network (VISN) 19 Mental Illness Research Education and Clinical Center (MIRECC), 1055 Clermont Street, Denver, CO 80220, USA
| | - Jeri E Forster
- Department of Veterans Affairs, Veteran Integrated Service Network (VISN) 19 Mental Illness Research Education and Clinical Center (MIRECC), 1055 Clermont Street, Denver, CO 80220, USA; Department of Biostatistics & Informatics, Colorado School of Public Health, University of Colorado Denver, 13001 E. 17th Place, Aurora, CO 80045, USA
| | - Lisa A Brenner
- Department of Veterans Affairs, Veteran Integrated Service Network (VISN) 19 Mental Illness Research Education and Clinical Center (MIRECC), 1055 Clermont Street, Denver, CO 80220, USA; Department of Psychiatry, School of Medicine, University of Colorado, 13001 East 17th Place, Aurora, CO 80045, USA; Department of Neurology, School of Medicine, University of Colorado, 13001 E. 17th Place, Aurora, CO 80045, USA; Department of Physical Medicine and Rehabilitation, School of Medicine, University of Colorado, 13001 E. 17th Place, Aurora, CO 80045, USA
| |
Collapse
|
13
|
Vestergaard V, Astrand R, Romner B. A survey of the management of paediatric minor head injury. Acta Neurol Scand 2014; 129:168-72. [PMID: 23763509 DOI: 10.1111/ane.12158] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/07/2013] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To investigate present established routines and standards in managing minor head-injured children in Danish hospitals, a survey of present management practice was conducted. MATERIALS AND METHODS A cross-sectional mail survey, detailing clinical and radiological examinations, in-hospital observation, discharge criteria and follow-up, was performed on all 46 hospitals treating children with minor head injury in Denmark. RESULTS Of the 46 hospitals, 33% report having established written criteria for the referral and management of children with minor head injury. Ten (22%) of the 46 hospitals are so-called injury clinics, where only nurses are employed. All state that they use the Glasgow Coma Scale (GCS) and/or the paediatric GCS to assess the level of consciousness; 15% use the paediatric GCS exclusively. None perform routine radiological examinations. Criteria for early discharge are established in 98% of the hospitals. All hospitals provide written instructions for observations at home before discharge. CONCLUSION The management of children with minor head injury varies between hospitals in Denmark. Local management guidelines are either lacking or mainly based on those of adults. Hence, there is a need for the development of minor head injury guidelines specifically designed for the management of children.
Collapse
Affiliation(s)
- V. Vestergaard
- Department of Neurosurgery; Rigshospitalet; Copenhagen Denmark
| | - R. Astrand
- Department of Neurosurgery; Rigshospitalet; Copenhagen Denmark
| | - B. Romner
- Department of Neurosurgery; Rigshospitalet; Copenhagen Denmark
| |
Collapse
|
14
|
[Home falls in infants before walking acquisition]. Arch Pediatr 2013; 20:484-91. [PMID: 23562734 DOI: 10.1016/j.arcped.2013.02.071] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2012] [Revised: 01/11/2013] [Accepted: 02/23/2013] [Indexed: 11/23/2022]
Abstract
UNLABELLED Minor head trauma is frequent among infants and leads to numerous visits to emergency departments for neurological assessment to evaluate the value of cerebral CT scan with the risk for traumatic brain injuries (TBI). OBJECTIVES To analyze the epidemiological characteristics of nonwalking infants admitted after falling at home and to analyze associated factors for skull fractures and TBI. PATIENTS AND METHODS Between January 2007 and December 2011, all children aged 9 months or younger and admitted after a home fall to the pediatric emergency unit of a tertiary children's hospital were included. The data collected were age, sex, weight and height, body mass index; geographic origin, referral or direct admission, mode of transportation; month, day and time of admission; causes of the fall, alleged fall height, presence of an eyewitness, type of landing surface; Glasgow Coma Scale (GCS) score, application of the head trauma protocol, location and type of injuries, cerebral CT scan results, length of hospital stay, progression, and neglect or abuse situations. RESULTS DESCRIPTIVE ANALYSIS: within the study period, 1910 infants were included. Fifty-four percent of children were aged less than 6 months with a slight male prevalence (52%). Falls from parental bed and infant carriers accounted for the most frequent fall circumstances. GCS score on admission was equal to 14 or 15 in 99% of cases. A cerebral CT scan was performed in 34% of children and detected 104 skull fractures and 55 TBI. Infants aged less than 1 month had the highest rate of TBI (8.5%). Eleven percent of patients were hospitalized. A situation of abuse was identified in 51 infants (3%). UNIVARIATE ANALYSIS: Male children and infants aged less than 3 months had a higher risk of skull fractures (P = 0.03 and P = 0.0003, respectively). In the TBI group, children were younger (3.8 ± 2.6 months versus 5.4 ± 2.5 months, P < 0.0001), fell from a higher height (90.2 ± 29.5 cm versus 70.9 ± 28.7 cm, P < 0.0001), were more often admitted on a weekend or day off, and had more skull fractures (54% versus 6%, P < 0.001). MULTIVARIATE ANALYSIS: all variables showing P < 0.2 in the univariate analysis were entered into the model. In the final model, three variables continued to be associated with a risk of TBI: being referred by a physician (OR 4.6 [2.2-9.6], P < 0.0001), being younger than 3 months old (OR 3.1 [1.7-5.7], P = 0.0002), falling from a height greater than 90 cm (OR 3.1 [1.7-5.6], P = 0.0002). COMMENTS Before walking acquisition, children are particularly vulnerable and have the highest rate of TBI after a vertical fall. In this age group, the rate of abuse is also higher. Given this double risk, numerous cerebral CT scans are performed (35-40% of the target population). This protocol, however, leads to a low proportion of detected TBI (<10%) compared to the high number of CT scans and an additional risk of irradiation. CONCLUSION As no validated predictive score exists and pending the contribution of the S-100B protein assay, the identification of infants at high risk for TBI and justifying neuroimaging is based on the search for predisposing factors and circumstances.
Collapse
|
15
|
Xydakis MS, Ling GSF, Mulligan LP, Dorlac WC, Hack DC. Reply: To PMID 23060246. Ann Neurol 2013; 74:152-4. [PMID: 23526742 DOI: 10.1002/ana.23895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Revised: 03/01/2013] [Accepted: 03/01/2013] [Indexed: 11/07/2022]
Affiliation(s)
- Michael S Xydakis
- Department of Surgery Traumatic Brain Injury Research Program, Uniformed Services University of the Health Sciences, Bethesda, MD; Walter Reed Army Medical Center, Washington, DC
| | | | | | | | | |
Collapse
|
16
|
Parri N, Crosby BJ, Glass C, Mannelli F, Sforzi I, Schiavone R, Ban KM. Ability of Emergency Ultrasonography to Detect Pediatric Skull Fractures: A Prospective, Observational Study. J Emerg Med 2013; 44:135-41. [PMID: 22579023 DOI: 10.1016/j.jemermed.2012.02.038] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2011] [Revised: 10/12/2011] [Accepted: 02/14/2012] [Indexed: 10/28/2022]
|
17
|
Xydakis MS, Ling GSF, Mulligan LP, Olsen CH, Dorlac WC. Epidemiologic aspects of traumatic brain injury in acute combat casualties at a major military medical center: A cohort study. Ann Neurol 2012; 72:673-81. [DOI: 10.1002/ana.23757] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2012] [Revised: 07/12/2012] [Accepted: 08/03/2012] [Indexed: 11/09/2022]
|
18
|
Lateef TM, Kriss R, Carpenter K, Nelson KB. Neurologic complaints in young children in the ED: when is cranial computed tomography helpful? Am J Emerg Med 2012; 30:1507-14. [PMID: 22386353 DOI: 10.1016/j.ajem.2011.12.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2011] [Revised: 12/12/2011] [Accepted: 12/13/2011] [Indexed: 11/16/2022] Open
Abstract
MAIN OBJECTIVE The objective of this study is to describe the use of emergent head computed tomography (CT) in young children and ask in which circumstances scans contributed to immediate management. METHODS We reviewed electronic records of children, aged 1 month through 6 years, who received a head CT at a large suburban emergency department between February 2008 and February 2009. Age, sex, chief complaint, history, physical examination, indication for and results of head CT, red flags in history or physical examination, final disposition, and number of head CT scans performed to date were recorded. Abnormalities on CT scans were classified as significant or incidental, and subsequent interventions were documented. RESULTS Emergent head CTs were performed on 394 children. The most common indications were trauma, 65%; seizure, 11%; and headache, 6%. Computed tomographic abnormalities were found in 40% (154 children): 32 significant findings,104 incidental findings, and 22 preexisting abnormalities. Four children with significant findings required immediate intervention. They all had red flags in both history and physical examination, and 3 of 4 children had known preexisting pathology; 1 child had nonaccidental trauma. Only 1 child had a significantly abnormal CT with no identifiable red flags; this child was admitted for observation and was discharged within 24 hours. Approximately a third of children had no readily identifiable red flag for the CT scans that they received. Of note, 20% of the young children had received more than 1 head CT scan to date, and 6% had between 6 and 20 scans. CONCLUSIONS Every child in this sample who required emergency intervention had red flags on history and physical examination. The 35% of CT scans performed in young children without red flags did not contribute usefully to their acute management.
Collapse
|
19
|
Abstract
PURPOSE Traumatic brain injury (TBI) is an important cause of morbidity and mortality in children. Despite the high incidence of head injury among children, the mortality rate is low. There is a lack of studies that describe children's age-specific symptoms in relation to outcome. The purpose is to investigate if other described symptoms could be used as a predictor of intracranial injury in children. METHODS Retrospective review of data from all children who during 1 year were admitted due to a brain injury. RESULTS During 1 year 724 children visited the ED due to a brain injury. A significant difference was found between age groups and other documented initial symptoms, but no single symptoms could be used as a predictor for intracranial injury. CONCLUSION Unconsciousness as a predictor for brain injury should be used with caution in children. Significant differences were found in other documented symptoms between age groups.
Collapse
Affiliation(s)
- Ann-Charlotte Falk
- Karolinska Institut, Woman and Child Health, Astrid Lindgren Childrens Hospital, Neuropediatric Research Unit, Stockholm, Sweden
| |
Collapse
|
20
|
Kuppermann N, Holmes JF, Dayan PS, Hoyle JD, Atabaki SM, Holubkov R, Nadel FM, Monroe D, Stanley RM, Borgialli DA, Badawy MK, Schunk JE, Quayle KS, Mahajan P, Lichenstein R, Lillis KA, Tunik MG, Jacobs ES, Callahan JM, Gorelick MH, Glass TF, Lee LK, Bachman MC, Cooper A, Powell EC, Gerardi MJ, Melville KA, Muizelaar JP, Wisner DH, Zuspan SJ, Dean JM, Wootton-Gorges SL. Identification of children at very low risk of clinically-important brain injuries after head trauma: a prospective cohort study. Lancet 2009; 374:1160-70. [PMID: 19758692 DOI: 10.1016/s0140-6736(09)61558-0] [Citation(s) in RCA: 1090] [Impact Index Per Article: 68.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND CT imaging of head-injured children has risks of radiation-induced malignancy. Our aim was to identify children at very low risk of clinically-important traumatic brain injuries (ciTBI) for whom CT might be unnecessary. METHODS We enrolled patients younger than 18 years presenting within 24 h of head trauma with Glasgow Coma Scale scores of 14-15 in 25 North American emergency departments. We derived and validated age-specific prediction rules for ciTBI (death from traumatic brain injury, neurosurgery, intubation >24 h, or hospital admission >or=2 nights). FINDINGS We enrolled and analysed 42 412 children (derivation and validation populations: 8502 and 2216 younger than 2 years, and 25 283 and 6411 aged 2 years and older). We obtained CT scans on 14 969 (35.3%); ciTBIs occurred in 376 (0.9%), and 60 (0.1%) underwent neurosurgery. In the validation population, the prediction rule for children younger than 2 years (normal mental status, no scalp haematoma except frontal, no loss of consciousness or loss of consciousness for less than 5 s, non-severe injury mechanism, no palpable skull fracture, and acting normally according to the parents) had a negative predictive value for ciTBI of 1176/1176 (100.0%, 95% CI 99.7-100 0) and sensitivity of 25/25 (100%, 86.3-100.0). 167 (24.1%) of 694 CT-imaged patients younger than 2 years were in this low-risk group. The prediction rule for children aged 2 years and older (normal mental status, no loss of consciousness, no vomiting, non-severe injury mechanism, no signs of basilar skull fracture, and no severe headache) had a negative predictive value of 3798/3800 (99.95%, 99.81-99.99) and sensitivity of 61/63 (96.8%, 89.0-99.6). 446 (20.1%) of 2223 CT-imaged patients aged 2 years and older were in this low-risk group. Neither rule missed neurosurgery in validation populations. INTERPRETATION These validated prediction rules identified children at very low risk of ciTBIs for whom CT can routinely be obviated. FUNDING The Emergency Medical Services for Children Programme of the Maternal and Child Health Bureau, and the Maternal and Child Health Bureau Research Programme, Health Resources and Services Administration, US Department of Health and Human Services.
Collapse
Affiliation(s)
- Nathan Kuppermann
- Department of Emergency Medicine, University of California, Davis School of Medicine, Davis, CA, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
21
|
Kuppermann N. Pediatric head trauma: the evidence regarding indications for emergent neuroimaging. Pediatr Radiol 2008; 38 Suppl 4:S670-4. [PMID: 18810402 DOI: 10.1007/s00247-008-0996-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2008] [Accepted: 08/13/2008] [Indexed: 11/29/2022]
Abstract
Traumatic brain injury (TBI) is a leading cause of childhood death and disability worldwide. In the United States, childhood head trauma results in approximately 3,000 deaths, 50,000 hospitalizations, and 650,000 emergency department (ED) visits annually. Children presenting to the ED with seemingly minor head trauma account for approximately one-half of children with documented TBIs. Despite the frequency and importance of childhood minor head trauma, there exists no highly accurate, reliable and validated clinical scoring system or prediction rule for assessing risk of TBI among those with minor head trauma. At the same time, use of CT scanning in these children in recent years has increased substantially. The major benefit of CT scanning is early identification (and treatment) of TBIs that might otherwise be missed and result in increased risk of morbidity and mortality. Unnecessary CT imaging, however, exposes the child needlessly to the risk of radiation-induced malignancies. What constitutes appropriate criteria for obtaining CT scans in children after minor blunt head trauma remains controversial. Current evidence to guide clinicians in this regard is limited; however, large studies performed in multi-center research networks have recently been conducted. These studies should provide the foundation of evidence to guide CT decisions by clinicians, help identify TBIs in a timely fashion, and reduce unnecessary radiation exposure.
Collapse
Affiliation(s)
- Nathan Kuppermann
- Department of Emergency Medicine, UC Davis Medical Center, Sacramento, CA 95817, USA.
| |
Collapse
|
22
|
Willis A, Latif S, Chandratre S, Stanhope B, Johnson K. Not a NICE CT protocol for the acutely head injured child. Clin Radiol 2008; 63:165-9. [DOI: 10.1016/j.crad.2007.05.027] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2007] [Revised: 05/18/2007] [Accepted: 05/22/2007] [Indexed: 11/16/2022]
|
23
|
Fung M, Willer B, Moreland D, Leddy JJ. A proposal for an evidenced-based emergency department discharge form for mild traumatic brain injury. Brain Inj 2007; 20:889-94. [PMID: 17062420 DOI: 10.1080/02699050600831934] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PRIMARY OBJECTIVE To examine and compare a sample of head injury care instruction forms available in hospital emergency departments (EDs) against evidence-based factors predictive of haemorrhage or traumatic lesions and to propose an easy-to-understand discharge instruction form for patients with concussion or mild traumatic brain injury (MTBI). RESEARCH DESIGN/METHODS Fifteen hospital discharge instruction forms were reviewed for inclusion of six factors known to be associated with the presence of haemorrhage after MTBI. ED instruction forms were also evaluated for readability. RESULTS The 15 hospital ED instruction forms varied in what patients' caretakers were instructed to observe. Some but not all important factors associated with haemorrhage were included. The mean Flesch-Kincaid reading grade level of the discharge instruction forms was 8.2 with a mean Reading Ease score of 59.9%. CONCLUSION EDs use discharge instruction forms listing signs and symptoms that are highly variable, confusing, not all evidence-based and often not easy to understand. This review proposes a discharge instruction form containing the six best evidence-based variables (according to the current literature) as being useful and understandable to patients and their families for home observation after MTBI.
Collapse
Affiliation(s)
- Michael Fung
- Department of Family Medicine, University of New York, Buffalo, NY, USA.
| | | | | | | |
Collapse
|
24
|
|
25
|
|
26
|
Falk AC, Klang B, Paavonen EJ, von Wendt L. Current incidence and management of children with traumatic head injuries: the Stockholm experience. Dev Neurorehabil 2007; 10:49-55. [PMID: 17608326 DOI: 10.1080/13638490600864066] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE A traumatic head injury is one of the most common causes of morbidity and mortality among children, however few population-based studies in this area have been reported. Therefore, the aim of this study was to evaluate the incidence and management of traumatic head injuries in children at a level-one trauma centre in Stockholm, Sweden. PARTICIPANTS All children (n = 3168) who visited the emergency department with a history of head injury during 1 year were included. METHOD The required information was collected retrospectively and the children's medical records were reviewed. RESULTS The overall incidences of head injury were 865 per 100 000 children with the highest incidence (2379/10(5) children) occurring among children younger than 18 months of age. Twelve per cent (n = 396) were admitted to a hospital ward and CT scans were performed in 13% (n = 412) of all children. During this year, 0.3% required a neurosurgical intervention and only 1% of all children had documentation of a planned follow-up appointment. CONCLUSION The findings indicate that clinical documentation as a part of the early management in children with a head injury is inconsistent and suffers from lack of valid criteria. Implementation of clinical guidelines during emergency care would help improve subsequent hospital care, as well as the planning of health care services for these children.
Collapse
Affiliation(s)
- Ann-Charlotte Falk
- Department of Women and Child Health-Neuropediatrics, Astrid Lindgren's Hospital for Children, Karolinska Institut, Stockholm, Sweden.
| | | | | | | |
Collapse
|
27
|
Cook RS, Schweer L, Shebesta KF, Hartjes K, Falcone RA. Mild traumatic brain injury in children: just another bump on the head? J Trauma Nurs 2006; 13:58-65. [PMID: 16884134 DOI: 10.1097/00043860-200604000-00007] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Mild traumatic brain injury (MTBI) is frequently encountered in pediatrics and challenges healthcare practitioners to provide safe, consistent, cost-effective care. Clinical management of children who sustain MTBI poses dilemmas for healthcare practitioners. This article will provide an overview of pediatric MTBI including definition, issues impacting diagnosis and management, risk factors for intracranial injury, indications for diagnostic imaging, disposition, and return to sports/activity. Knowledge and understanding of MTBI in children aid healthcare practitioners to make informed competent recommendations for care. Clinicians must have a thorough understanding and working knowledge of pediatric MTBI to aid clinical decisions and optimize patient outcomes.
Collapse
Affiliation(s)
- Rebecca S Cook
- Division of Pediatric and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue ML 3019, Cincinnati, OH 45229, USA.
| | | | | | | | | |
Collapse
|
28
|
Bello Pedrosa O, Prego Petit J, Stewart Davies J, Robuschi Lestouquet F. Tratamiento del traumatismo craneoencefálico aislado leve. Estudio multicéntrico. An Pediatr (Barc) 2006; 65:44-50. [PMID: 16945290 DOI: 10.1157/13090897] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To detect intracranial injuries (ICI) earlier in children with minor head trauma through the use of a previously established decision tree. METHOD We performed a prospective multicenter study from September 2003 to January 2005. All patients aged between 3 months and 14 years old who visited the emergency department with minor head trauma (Glasgow Coma Scale score 13-15) were included. Six situations were established according to age (older or younger than 2 years) and low, intermediate or high risk for ICI. The management of each situation was suggested: observation at home, hospital observation or computed tomography (CT). The records of all patients were audited and categorized into: "properly classified, correct management", "properly classified but incorrect management", and "wrongly classified". All the patients were followed-up after discharge. RESULTS A total of 2148 patients were included. Low risk was assigned to 54.8 %, intermediate risk to 32.4 %, and high risk to 12.8 %. Observation at home or in hospital was assigned to 53.4 % and 24 % respectively. CT was performed in 22.6 %. ICI was detected in 1.6 % and 0.32 % required neurosurgery. There were 25 ICI in the high risk group, seven in the intermediate risk group, and none in the low risk group. No ICI were detected during follow-up. Most patients (90.1 %) were properly classified and the proposed management was carried out in 87.4 %. CONCLUSIONS When the recommendations of the management protocol were applied, early detection of ICI was achieved in all the situations in which these lesions occurred.
Collapse
Affiliation(s)
- O Bello Pedrosa
- Departamento de Emergencia Pediátrica, Centro Hospitalario Pereira Rossell, Montevideo, Uruguay.
| | | | | | | |
Collapse
|
29
|
Kirkwood MW, Yeates KO, Wilson PE. Pediatric sport-related concussion: a review of the clinical management of an oft-neglected population. Pediatrics 2006; 117:1359-71. [PMID: 16585334 DOI: 10.1542/peds.2005-0994] [Citation(s) in RCA: 214] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Athletic concussion is a growing focus of attention for pediatricians. Although numerous literature reviews and clinical guidelines are now available pertaining to athletic concussion, few have focused on the pediatric athlete in particular. Sport-related concussions occur relatively frequently in children and adolescents, and primary health care providers are often responsible for coordinating clinical management. Here we summarize the scientific literature pertinent to the care of young athletes. We examine how concussion affects younger and older athletes differently at biomechanical, pathophysiological, neurobehavioral, and contextual levels. We also discuss important issues in clinical management, including preparticipation assessment, concussion evaluation and recovery tracking, and when and how to return pediatric athletes to play sports. We also briefly cover non-sport-related interventions (eg, school support). With proper management, most children and adolescents sustaining a sport-related concussion can be expected to recover fully.
Collapse
Affiliation(s)
- Michael W Kirkwood
- Department of Physical Medicine and Rehabilitation, Children's Hospital, Denver, Colorado, USA.
| | | | | |
Collapse
|
30
|
Gessler P. Evaluation of pediatric head trauma in the emergency department. Eur J Pediatr 2006; 165:141. [PMID: 16311739 DOI: 10.1007/s00431-005-0020-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2005] [Accepted: 08/08/2005] [Indexed: 11/30/2022]
|
31
|
Da Dalt L, Marchi AG, Laudizi L, Crichiutti G, Messi G, Pavanello L, Valent F, Barbone F. Predictors of intracranial injuries in children after blunt head trauma. Eur J Pediatr 2006; 165:142-8. [PMID: 16311740 DOI: 10.1007/s00431-005-0019-6] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2005] [Revised: 06/16/2005] [Accepted: 08/08/2005] [Indexed: 01/21/2023]
Abstract
UNLABELLED This study was conducted to determine if clinical features can predict the risk of intracranial injury (ICI) in pediatric closed head trauma. We enrolled 3,806 children under 16 years consecutively referred for acute closed head trauma to the paediatric emergency room of five Italian children's hospitals. Relevant outcomes were death and diagnosis of ICI. Clinical symptoms and signs were evaluated as possible outcome predictors. Children were also classified into five groups according to their clinical presentation. The association of ICI with signs and symptoms and the appropriateness of the five-group classification in predicting the likelihood of ICI were evaluated by logistic regression analyses. ICI was diagnosed in 22 children; 2 of them died. The risk of fatal and nonfatal ICI was 0.5 and 5.2 per 1,000 children with closed head trauma respectively. Significant associations were found between ICI and loss of consciousness, prolonged headache, persistent drowsiness, abnormal mental status, focal neurological signs, signs of skull fracture in non-frontal areas and signs of basal skull fracture. The five-group classification of children allowed an excellent prediction in terms of likelihood of ICI (ROC area 0.972). CONCLUSIONS Selection of children with closed head trauma based on different combinations of signs and symptoms allows for early identification of subjects at different risk for ICI. In patients with minor head injuries, the absence of loss of consciousness, drowsiness, amnesia, prolonged headache, clinical evidence of basal or non-frontal skull fracture identified 100% of children without lesions. Validation of our results with a larger sample of patients with ICI would be highly desirable.
Collapse
Affiliation(s)
- Liviana Da Dalt
- Dipartimento di Pediatria, Università di Padova, Via Giustiniani 3, 35128, Padova, Italy.
| | | | | | | | | | | | | | | |
Collapse
|
32
|
Abstract
Many studies have found conflicting evidence over the use of clinical indicators to predict intracranial injury in pediatric mild head injury. Although altered mental status, loss of consciousness, and abnormal neurologic examination have all been found to be more prevalent among head-injured children, studies have observed inconsistent results over their specificity and predictive value. Children older than 2 years have been evaluated, managed, and studied differently than those less than 2 years old. Evidence strongly supports a lower threshold to perform a CT scan in younger children because they have a higher risk of significant brain injury after blunt head trauma.
Collapse
Affiliation(s)
- Mary L Thiessen
- Department of Emergency Medicine, University of Arizona, 1515 North Campbell Avenue, Tucson, AZ 85724, USA
| | | |
Collapse
|
33
|
Bru M, Nouyrigat V, Landrieu P. Manifestations neurologiques spectaculaires après traumatisme crânien bénin : étude rétrospective de 51 enfants. Arch Pediatr 2006; 13:17-22. [PMID: 16239099 DOI: 10.1016/j.arcped.2005.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2005] [Accepted: 09/14/2005] [Indexed: 10/25/2022]
Abstract
UNLABELLED Mild head traumas, as a rule, remain a- or paucisymptomatic. In a few cases however, spectacular manifestations develop despite absence of intracerebral lesion. POPULATION, METHODS: We have studied retrospectively 51 such children and contacted their family in order to clarify the follow-up. RESULTS The dominant symptoms allowed to categorize the following situations: syncope-like loss of consciousness (11 cases), seizures (6), severe headaches with neurologic signs (15), confusion (8), visual disorders (6), amnesic ictus (5). Recurrences were possible but benign: in 8/11 children in the group "syncopes", in 1/6 in the group "seizures", in 5/21 in the 4 other groups. In the latter 4 groups, 11/21 children developed common migraine. Except for the only case who developed epilepsy later on, scholarship was normal in the 25 cases with sufficient follow-up. DISCUSSION Beside syncopes and seizures, the long-lasting episodes suggested a migrainous pathogeny, perhaps at a maturative stage where the trigger of migrainous mechanism is at a low level in the brain. CONCLUSION The mildness of the knock, the normality of CT scan including when the symptoms are present and the normality of both consciousness and examination once the symptoms have disappeared allow to avoid further investigations.
Collapse
Affiliation(s)
- M Bru
- Service de neurologie pédiatrique, service des urgences pédiatriques, hôpital Bicêtre, Assistance-publique-Hôpitaux-de-Paris, 94270, France
| | | | | |
Collapse
|
34
|
Bibliography. Current world literature. Child and Adolescent psychiatry. Curr Opin Psychiatry 2005; 18:455-66. [PMID: 16639142 DOI: 10.1097/01.yco.0000172068.09144.02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
35
|
Evaluation and Management of Pediatric Head Trauma in the Emergency Department: Current Concepts and State-of-the-Art Research. CLINICAL PEDIATRIC EMERGENCY MEDICINE 2005. [DOI: 10.1016/j.cpem.2004.12.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
36
|
|
37
|
Millichap JG. Risks of Brain Injury after Blunt Head Trauma. Pediatr Neurol Briefs 2004. [DOI: 10.15844/pedneurbriefs-18-6-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
|