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Tavender E, Eapen N, Wang J, Rausa VC, Babl FE, Phillips N. Triage tools for detecting cervical spine injury in paediatric trauma patients. Cochrane Database Syst Rev 2024; 3:CD011686. [PMID: 38517085 PMCID: PMC10958760 DOI: 10.1002/14651858.cd011686.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Abstract
BACKGROUND Paediatric cervical spine injury (CSI) after blunt trauma is rare but can have severe consequences. Clinical decision rules (CDRs) have been developed to guide clinical decision-making, minimise unnecessary tests and associated risks, whilst detecting all significant CSIs. Several validated CDRs are used to guide imaging decision-making in adults following blunt trauma and clinical criteria have been proposed as possible paediatric-specific CDRs. Little information is known about their accuracy. OBJECTIVES To assess and compare the diagnostic accuracy of CDRs or sets of clinical criteria, alone or in comparison with each other, for the evaluation of CSI following blunt trauma in children. SEARCH METHODS For this update, we searched CENTRAL, MEDLINE, Embase, and six other databases from 1 January 2015 to 13 December 2022. As we expanded the index test eligibility for this review update, we searched the excluded studies from the previous version of the review for eligibility. We contacted field experts to identify ongoing studies and studies potentially missed by the search. There were no language restrictions. SELECTION CRITERIA We included cross-sectional or cohort designs (retrospective and prospective) and randomised controlled trials that compared the diagnostic accuracy of any CDR or clinical criteria compared with a reference standard for the evaluation of paediatric CSI following blunt trauma. We included studies evaluating one CDR or comparing two or more CDRs (directly and indirectly). We considered X-ray, computed tomography (CT) or magnetic resonance imaging (MRI) of the cervical spine, and clinical clearance/follow-up as adequate reference standards. DATA COLLECTION AND ANALYSIS Two review authors independently screened titles and abstracts for relevance, and carried out eligibility, data extraction and quality assessment. A third review author arbitrated. We extracted data on study design, participant characteristics, inclusion/exclusion criteria, index test, target condition, reference standard and data (diagnostic two-by-two tables) and calculated and plotted sensitivity and specificity on forest plots for visual examination of variation in test accuracy. We assessed methodological quality using the Quality Assessment of Diagnostic Accuracy Studies Version 2 tool. We graded the certainty of the evidence using the GRADE approach. MAIN RESULTS We included five studies with 21,379 enrolled participants, published between 2001 and 2021. Prevalence of CSI ranged from 0.5% to 1.85%. Seven CDRs were evaluated. Three studies reported on direct comparisons of CDRs. One study (973 participants) directly compared the accuracy of three index tests with the sensitivities of NEXUS, Canadian C-Spine Rule and the PECARN retrospective criteria being 1.00 (95% confidence interval (CI) 0.48 to 1.00), 1.00 (95% CI 0.48 to 1.00) and 1.00 (95% CI 0.48 to 1.00), respectively. The specificities were 0.56 (95% CI 0.53 to 0.59), 0.52 (95% CI 0.49 to 0.55) and 0.32 (95% CI 0.29 to 0.35), respectively (moderate-certainty evidence). One study (4091 participants) compared the accuracy of the PECARN retrospective criteria with the Leonard de novo model; the sensitivities were 0.91 (95% CI 0.81 to 0.96) and 0.92 (95% CI 0.83 to 0.97), respectively. The specificities were 0.46 (95% CI 0.44 to 0.47) and 0.50 (95% CI 0.49 to 0.52) (moderate- and low-certainty evidence, respectively). One study (270 participants) compared the accuracy of two NICE (National Institute for Health and Care Excellence) head injury guidelines; the sensitivity of the CG56 guideline was 1.00 (95% CI 0.48 to 1.00) compared to 1.00 (95% CI 0.48 to 1.00) with the CG176 guideline. The specificities were 0.46 (95% CI 0.40 to 0.52) and 0.07 (95% CI 0.04 to 0.11), respectively (very low-certainty evidence). Two additional studies were indirect comparison studies. One study (3065 participants) tested the accuracy of the NEXUS criteria; the sensitivity was 1.00 (95% CI 0.88 to 1.00) and specificity was 0.20 (95% CI 0.18 to 0.21) (low-certainty evidence). One retrospective study (12,537 participants) evaluated the PEDSPINE criteria and found a sensitivity of 0.93 (95% CI 0.78 to 0.99) and specificity of 0.70 (95% CI 0.69 to 0.72) (very low-certainty evidence). We did not pool data within the broader CDR categories or investigate heterogeneity due to the small quantity of data and the clinical heterogeneity of studies. Two studies were at high risk of bias. We identified two studies that are awaiting classification pending further information and two ongoing studies. AUTHORS' CONCLUSIONS There is insufficient evidence to determine the diagnostic test accuracy of CDRs to detect CSIs in children following blunt trauma, particularly for children under eight years of age. Although most studies had a high sensitivity, this was often achieved at the expense of low specificity and should be interpreted with caution due to a small number of CSIs and wide CIs. Well-designed, large studies are required to evaluate the accuracy of CDRs for the cervical spine clearance in children following blunt trauma, ideally in direct comparison with each other.
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Affiliation(s)
- Emma Tavender
- Emergency Research, Murdoch Children's Research Institute, Melbourne, Australia
- Departments of Paediatrics and Critical Care, University of Melbourne, Melbourne, Australia
| | - Nitaa Eapen
- Emergency Research, Murdoch Children's Research Institute, Melbourne, Australia
| | - Junfeng Wang
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
| | - Vanessa C Rausa
- Emergency Research, Murdoch Children's Research Institute, Melbourne, Australia
| | - Franz E Babl
- Emergency Research, Murdoch Children's Research Institute, Melbourne, Australia
- Departments of Paediatrics and Critical Care, University of Melbourne, Melbourne, Australia
- Emergency Department, The Royal Children's Hospital, Melbourne, Australia
| | - Natalie Phillips
- Emergency Department, Queensland Children's Hospital, Children's Health Queensland, Brisbane, Australia
- Child Health Research Centre, University of Queensland, Brisbane, Australia
- Biomechanics and Spine Research Group, Centre for Children's Health Research, School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, Australia
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Babl FE, Eapen N, Herd D, Borland ML, Kochar A, Lawton B, Hort J, West A, George S, Davidson A, Cheek JA, Oakley E, Hopper SM, Berkowitz RG, Wilson CL, Williams A, MacKay MT, Lee KJ, Hearps S, Dalziel SR. Pain in children with Bell's palsy: secondary analysis of a randomised controlled trial. Arch Dis Child 2024; 109:227-232. [PMID: 38049992 DOI: 10.1136/archdischild-2023-325381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 11/18/2023] [Indexed: 12/06/2023]
Abstract
OBJECTIVE To describe the prevalence and severity of pain experienced by children with Bell's palsy over the first 6 months of illness and its association with the severity of facial paralysis. METHODS This was a secondary analysis of data obtained in a phase III, triple-blinded, randomised, placebo-controlled trial of prednisolone for the treatment of Bell's palsy in children aged 6 months to <18 years conducted between 13 October 2015 and 23 August 2020 in Australia and New Zealand. Children were recruited within 72 hours of symptom onset and pain was assessed using a child-rated visual analogue scale (VAS), a child-rated Faces Pain Score-Revised (FPS-R) and/or a parent-rated VAS at baseline, and at 1, 3 and 6 months until recovered, and are reported combined across treatment groups. RESULTS Data were available for 169 of the 187 children randomised from at least one study time point. Overall, 37% (62/169) of children reported any pain at least at one time point. The frequency of any pain reported using the child-rated VAS, child-rated FPS-R and parent-rated VAS was higher at the baseline assessment (30%, 23% and 27%, respectively) compared with 1-month (4%, 0% and 4%, respectively) and subsequent follow-up assessments. At all time points, the median pain score on all three scales was 0 (no pain). CONCLUSIONS Pain in children with Bell's palsy was infrequent and primarily occurred early in the disease course and in more severe disease. The intensity of pain, if it occurs, is very low throughout the clinical course of disease. TRIAL REGISTRATION NUMBER ACTRN12615000563561.
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Affiliation(s)
- Franz E Babl
- Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
- Emergency Department, The Royal Children's Hospital, Parkville, Victoria, Australia
- Department of Critical Care, University of Melbourne, Parkville, Victoria, Australia
| | - Nitaa Eapen
- Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Emergency Department, The Royal Children's Hospital, Parkville, Victoria, Australia
| | - David Herd
- Emergency Department, Queensland Children's Hospital, South Brisbane, Queensland, Australia
- University of Queensland, Brisbane, Queensland, Australia
| | - Meredith L Borland
- Emergency Department, Perth Children's Hospital, Nedlands, Perth, Australia
- Divisions of Paediatrics and Emergency Medicine, University of Western Australia, Crawley, Western Australia, Australia
| | - Amit Kochar
- Department of Acute Care Medicine, University of Adelaide, Adelaide, South Australia, Australia
- Emergency Department, Women's and Children's Hospital, North Adelaide, South Australia, Australia
| | - Ben Lawton
- Emergency Department, Logan Hospital, Brisbane, Queensland, Australia
| | - Jason Hort
- Emergency Department, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Adam West
- Emergency Department, Monash Medical Centre, Clayton, Victoria, Australia
| | - Shane George
- Department of Emergency Medicine, Gold Coast University Hospital, Southport, Queensland, Australia
- School of Medicine and Menzies Health Institute Queensland, Griffith University, Southport, Queensland, Australia
| | - Andrew Davidson
- Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
- Department of Anesthesia and Pain Management, Royal Children's Hospital, Parkville, Victoria, Australia
| | - John A Cheek
- Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
- Emergency Department, The Royal Children's Hospital, Parkville, Victoria, Australia
| | - Ed Oakley
- Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
- Emergency Department, The Royal Children's Hospital, Parkville, Victoria, Australia
- Department of Critical Care, University of Melbourne, Parkville, Victoria, Australia
| | - Sandy M Hopper
- Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
- Emergency Department, The Royal Children's Hospital, Parkville, Victoria, Australia
| | - Robert G Berkowitz
- Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Catherine L Wilson
- Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Amanda Williams
- Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Mark T MacKay
- Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - Katherine J Lee
- Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
- Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Stephen Hearps
- Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Critical Care, University of Melbourne, Parkville, Victoria, Australia
| | - Stuart R Dalziel
- Children's Emergency Department, Starship Children's Hospital, Auckland, New Zealand
- Departments of Surgery and Paediatrics, Child and Youth Health, University of Auckland, Auckland, New Zealand
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3
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Parr M, Wilson CL, Jones B, Crawford NW, Ferguson S, Ramesh S, Eapen N, Craig S, Hearps S, Babl FE. Emergency department presentations for chest complaints after mRNA COVID-19 vaccinations in children and adolescents. Emerg Med Australas 2024; 36:110-117. [PMID: 37872323 PMCID: PMC10953413 DOI: 10.1111/1742-6723.14327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 09/15/2023] [Indexed: 10/25/2023]
Abstract
OBJECTIVE To investigate characteristics and management of children presenting with chest complaints to a tertiary paediatric ED post-mRNA COVID-19 vaccine. METHODS This was a retrospective medical record review with data linkage to the Australian Immunisation Register. The study setting was the Royal Children's Hospital, Melbourne, Australia. Children <18 years who had a troponin blood test performed in hospital within 14 days of receiving mRNA COVID-19 vaccination were included. Elevated troponin and myocarditis or pericarditis as per Brighton criteria was the primary outcome. Vaccination status, length of stay, investigations and clinical management were secondary outcomes. RESULTS Six hundred and ten patients had a troponin test in 13 months. After exclusion of trauma-related tests (n = 31), known cardiac patients (n = 75) and others (n = 145), 359 troponins were obtained due to chest complaints and related symptoms, with 283 troponins assessed to be mRNA vaccination-related. There was a temporal peak in presentations with a 30-fold monthly increase in troponin post-commencement of mRNA COVID-19 vaccines. In those with chest complaints following mRNA vaccination, mean age was 14 years and 50.4% were female. Fourteen out of 283 (5%) vaccine-related troponins were abnormal with 14 patients assessed to have vaccine-associated myocarditis. No patients had pericarditis. CONCLUSIONS There was a large number of possible mRNA COVID-19 vaccine-related chest complaints presenting to the ED. Few patients had abnormal troponins or myocarditis.
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Affiliation(s)
- Mandy Parr
- Emergency DepartmentThe Royal Children's HospitalMelbourneVictoriaAustralia
- Clinical SciencesMurdoch Children's Research InstituteMelbourneVictoriaAustralia
- Monash Emergency Program, Paediatric Emergency Department, Monash Medical CentreMonash HealthMelbourneVictoriaAustralia
| | - Catherine L Wilson
- Clinical SciencesMurdoch Children's Research InstituteMelbourneVictoriaAustralia
| | - Bryn Jones
- Clinical SciencesMurdoch Children's Research InstituteMelbourneVictoriaAustralia
- Department of CardiologyThe Royal Children's HospitalMelbourneVictoriaAustralia
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health SciencesThe University of MelbourneMelbourneVictoriaAustralia
| | - Nigel W Crawford
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health SciencesThe University of MelbourneMelbourneVictoriaAustralia
- Immunisation ServicesThe Royal Children's HospitalMelbourneVictoriaAustralia
- SAEFVIC, Infection, Immunity and Global HealthMurdoch Children's Research InstituteMelbourneVictoriaAustralia
| | - Steven Ferguson
- Emergency DepartmentThe Royal Children's HospitalMelbourneVictoriaAustralia
| | - Sailavan Ramesh
- Centre for Health AnalyticsMurdoch Children's Research InstituteMelbourneVictoriaAustralia
| | - Nitaa Eapen
- Emergency DepartmentThe Royal Children's HospitalMelbourneVictoriaAustralia
- Clinical SciencesMurdoch Children's Research InstituteMelbourneVictoriaAustralia
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health SciencesThe University of MelbourneMelbourneVictoriaAustralia
| | - Simon Craig
- Clinical SciencesMurdoch Children's Research InstituteMelbourneVictoriaAustralia
- Monash Emergency Program, Paediatric Emergency Department, Monash Medical CentreMonash HealthMelbourneVictoriaAustralia
- Department of Paediatrics, School of Clinical Sciences at Monash HealthMonash UniversityMelbourneVictoriaAustralia
| | - Stephen Hearps
- Clinical SciencesMurdoch Children's Research InstituteMelbourneVictoriaAustralia
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health SciencesThe University of MelbourneMelbourneVictoriaAustralia
| | - Franz E Babl
- Emergency DepartmentThe Royal Children's HospitalMelbourneVictoriaAustralia
- Clinical SciencesMurdoch Children's Research InstituteMelbourneVictoriaAustralia
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health SciencesThe University of MelbourneMelbourneVictoriaAustralia
- Department of Paediatrics, School of Clinical Sciences at Monash HealthMonash UniversityMelbourneVictoriaAustralia
- Department of Critical CareFaculty of Medicine, Dentistry and Health Sciences, The University of MelbourneMelbourneVictoriaAustralia
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4
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Borland ML, Dalziel SR, Phillips N, Dalton S, Lyttle MD, Bressan S, Oakley E, Kochar A, Furyk J, Cheek JA, Neutze J, Eapen N, Hearps SJC, Rausa VC, Babl FE. Incidence of traumatic brain injuries in head-injured children with seizures. Emerg Med Australas 2023; 35:289-296. [PMID: 36323396 PMCID: PMC10947265 DOI: 10.1111/1742-6723.14112] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 09/01/2022] [Accepted: 10/05/2022] [Indexed: 03/20/2023]
Abstract
OBJECTIVE Incidence and short-term outcomes of clinically important traumatic brain injury (ciTBI) in head-injured children presenting to ED with post-traumatic seizure (PTS) is not described in current literature. METHODS Planned secondary analysis of a prospective observational study undertaken in 10 Australasian Paediatric Research in Emergency Departments International Collaborative (PREDICT) network EDs between 2011 and 2014 of head-injured children <18 years with and without PTS. Clinical predictors and outcomes were analysed by attributable risk (AR), risk ratios (RR) and 95% confidence interval (CI), including the association with Glasgow Coma Scale (GCS) scores. RESULTS Of 20 137 head injuries, 336 (1.7%) had PTS with median age of 4.8 years. Initial GCS was 15 in 268/336 (79.8%, AR -16.1 [95% CI -20.4 to -11.8]), 14 in 24/336 (7.1%, AR 4.4 [95% CI 1.6-7.2]) and ≤13 in 44/336 (13.1%, AR 11.7 [95% CI 8.1-15.3]) in comparison with those without PTS, respectively. The ciTBI rate was 34 (10.1%) with PTS versus 219 (1.1%) without PTS (AR 9.0 [95% CI 5.8-12.2]) with 5/268 (1.9%), 6/24 (25.0%) and 23/44 (52.3%) with GCS 15, 14 and ≤13, respectively. In PTS, rates of admission ≥2 nights (34 [10.1%] AR 9.0 [95% CI 5.8-12.3]), intubation >24 h (9 [2.7%] AR 2.5 [95% CI 0.8-4.2]) and neurosurgery (8 [2.4%] AR 2.0 [95% CI 0.4-3.7]), were higher than those without PTS. Children with PTS and GCS 15 or 14 had no neurosurgery, intubations or death, with two deaths in children with PTS and GCS ≤13. CONCLUSIONS PTS was uncommon in head-injured children presenting to the ED but associated with an increased risk of ciTBI in those with reduced GCS on arrival.
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Affiliation(s)
- Meredith L Borland
- Emergency DepartmentPerth Children's HospitalPerthWestern AustraliaAustralia
- Divisions of Paediatrics and Emergency Medicine, School of MedicineThe University of Western AustraliaPerthWestern AustraliaAustralia
| | - Stuart R Dalziel
- Children's Emergency DepartmentStarship Children's HospitalAucklandNew Zealand
- Departments of Surgery and Paediatrics: Child and Youth HealthThe University of AucklandAucklandNew Zealand
| | - Natalie Phillips
- Emergency DepartmentQueensland Children's HospitalBrisbaneQueenslandAustralia
- Child Health Research Centre, School of MedicineThe University of QueenslandBrisbaneQueenslandAustralia
| | - Sarah Dalton
- Emergency DepartmentThe Children's Hospital at WestmeadSydneyNew South WalesAustralia
| | - Mark D Lyttle
- Emergency DepartmentBristol Royal Hospital for ChildrenBristolUK
- Academic Department of Emergency CareUniversity of the West of EnglandBristolUK
| | - Silvia Bressan
- Department of Women's and Children's HealthUniversity of PadovaPadovaItaly
| | - Ed Oakley
- Emergency DepartmentThe Royal Children's HospitalMelbourneVictoriaAustralia
- Department of Paediatrics and Centre for Integrated Critical Care, Faculty of Medicine, Dentistry and Health SciencesThe University of MelbourneMelbourneVictoriaAustralia
| | - Amit Kochar
- Emergency DepartmentWomen's and Children's HospitalAdelaideSouth AustraliaAustralia
| | - Jeremy Furyk
- Emergency DepartmentThe Townsville HospitalTownsvilleQueenslandAustralia
- School of MedicineDeakin UniversityMelbourneVictoriaAustralia
- University Hospital GeelongGeelongVictoriaAustralia
| | - John A Cheek
- Emergency DepartmentThe Royal Children's HospitalMelbourneVictoriaAustralia
- Department of Paediatrics and Centre for Integrated Critical Care, Faculty of Medicine, Dentistry and Health SciencesThe University of MelbourneMelbourneVictoriaAustralia
| | - Jocelyn Neutze
- Emergency DepartmentKidz First Children's HospitalAucklandNew Zealand
| | - Nitaa Eapen
- Murdoch Children's Research InstituteMelbourneVictoriaAustralia
| | | | - Vanessa C Rausa
- Murdoch Children's Research InstituteMelbourneVictoriaAustralia
| | - Franz E Babl
- Emergency DepartmentThe Royal Children's HospitalMelbourneVictoriaAustralia
- Department of Paediatrics and Centre for Integrated Critical Care, Faculty of Medicine, Dentistry and Health SciencesThe University of MelbourneMelbourneVictoriaAustralia
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Williams A, Eapen N, Kochar A, Lawton B, Hort J, West A, George S, Berkowitz R, Lee KJ, Dalziel SR, Hearps S, Babl FE. Agreement Between House-Brackmann and Sunnybrook Facial Nerve Grading Systems in Bell's Palsy in Children: Secondary Analysis of a Randomized, Placebo-Controlled Multicenter Trial. J Child Neurol 2023; 38:44-51. [PMID: 36740927 DOI: 10.1177/08830738221144082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND There is limited evidence on the use of facial nerve function grading scales in acute facial nerve paralysis in children. OBJECTIVE To investigate the agreement between and the usability of the House-Brackmann and Sunnybrook scales in children with idiopathic facial paralysis (Bell's palsy) and to compare their ease of administration. METHODS Data from a randomized controlled trial in children aged 6 months to <18 years with Bell's palsy was used. Children were recruited within 72 hours of symptom onset and assessed using the House-Brackmann and the Sunnybrook scales at baseline and at 1, 3, and 6 months until recovered. Agreement between the scales was assessed using the intraclass correlation coefficient (ICC) at each time point and using a Bland-Altman plot. Ease of administration was assessed using an 11-point Likert scale. RESULTS Comparative data were available for 169 of the 187 children randomized. The ICC between the 2 scales across all time points was 0.92 (95% confidence interval [CI] 0.91-0.93), at baseline 0.37 (95% 0.25, 0.51), at 1 month 0.91 (95% CI 0.89-0.94), at 3 months 0.85 (95% CI 0.80-0.89), and at 6 months 0.96 (95% CI 0.95-0.97). The median score for the ease of administration for the House-Brackmann and Sunnybrook scales was 3 (interquartile range [IQR]: 1-5) and 7 (IQR: 4-8) respectively (P < .001, Wilcoxon signed-rank test). CONCLUSIONS There was excellent agreement between House-Brackmann and Sunnybrook scales, with poorer agreement at baseline. Clinicians found the House-Brackmann scale easier to administer. These findings suggest that both scales can be applied in children.
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Affiliation(s)
- Amanda Williams
- Emergency Department, Royal Children's Hospital, Parkville, Victoria, Australia.,Clinical Sciences, 34361Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Nitaa Eapen
- Emergency Department, Royal Children's Hospital, Parkville, Victoria, Australia.,Clinical Sciences, 34361Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Victoria, Australia
| | - Amit Kochar
- Emergency Department, Women's and Children's Hospital, Adelaide, Australia
| | - Ben Lawton
- Emergency Department, 4607Logan Hospital, Brisbane, Queensland, Australia
| | - Jason Hort
- Emergency Department, 8538The Children's Hospital at Westmead, Sydney, Australia
| | - Adam West
- Emergency Department, Monash Medical Centre, Clayton, Victoria, Australia
| | - Shane George
- Department of Emergency Medicine, Gold Coast University Hospital, Southport, Australia.,School of Medicine and Menzies Health Institute Queensland, Griffith University, Southport, Australia
| | - Robert Berkowitz
- Clinical Sciences, 34361Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Victoria, Australia.,Department of Otolaryngology, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Katherine J Lee
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Victoria, Australia.,Clinical Epidemiology and Biostatistics Unit, 34361Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Stuart R Dalziel
- Children's Emergency Department, Starship Children's Hospital, Auckland, New Zealand.,Departments of Surgery and Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand
| | - Stephen Hearps
- Clinical Sciences, 34361Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Franz E Babl
- Emergency Department, Royal Children's Hospital, Parkville, Victoria, Australia.,Clinical Sciences, 34361Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Victoria, Australia.,Department of Critical Care, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Victoria, Australia
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6
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Babl FE, Eapen N, Herd D, Borland ML, Kochar A, Zhang M, Oakley E, Hopper SM, Berkowitz RG, Wilson CL, Williams A, Mackay MT, Lee KJ, Hearps S. Agreement of Clinician‐Administered and Modified Parent‐Administered House‐Brackmann Scales in Children with Bell's Palsy. OTO Open 2023; 7:e44. [PMID: 36998545 PMCID: PMC10046699 DOI: 10.1002/oto2.44] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 02/01/2023] [Indexed: 03/30/2023] Open
Abstract
Objective Currently there is no parent administered scale for facial nerve function in children. We set out to assess the agreement between a newly developed parent-administered modified version of the House-Brackmann (HB) scale and the standard clinician-administered HB scale in children with Bell's palsy. Study Design Secondary analysis of a triple-blind, randomized, placebo-controlled trial of corticosteroids to treat idiopathic facial paralysis (Bell's palsy) in children (6 months to <18 years). Setting Multicenter study at pediatric hospitals with recruitment in emergency departments. Methods Children were recruited within 72 hours of symptom onset and assessed using the clinician-administered and the parent-administered modified HB scales at baseline, and at 1, 3, and 6 months until recovered. Agreement between the 2 scales was assessed using intraclass coefficient (ICC) and a Bland-Altman plot. Results Data were available for 174 of the 187 children randomized from at least 1 study time point. The mean ICC between clinician and parent HB scores across all time points was 0.88 (95% confidence interval, CI: 0.86, 0.90). The ICC for the data collected at baseline was 0.53 (95% CI: 0.43, 0.64), at 1 month was 0.88 (95% CI: 0.84, 0.91), at 3 months was 0.80 (95% CI: 0.71, 0.87) and at 6 months was 0.73 (95% CI: 0.47, 0.89). A Bland-Altman plot indicated a mean difference between the 2 scores (clinician-reported minus parent-reported) of only -0.07 (95% limits of agreement -1.37 to 1.23). Conclusion There was good agreement between the modified parent-administered and the clinician-administered HB scales.
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Affiliation(s)
- Franz E. Babl
- Emergency DepartmentRoyal Children's HospitalParkvilleVictoriaAustralia
- Clinical Sciences, Murdoch Children's Research InstituteParkvilleVictoriaAustralia
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health SciencesUniversity of MelbourneParkvilleVictoriaAustralia
- Department of Critical Care, Faculty of Medicine, Dentistry and Health SciencesUniversity of MelbourneParkvilleVictoriaAustralia
| | - Nitaa Eapen
- Emergency DepartmentRoyal Children's HospitalParkvilleVictoriaAustralia
- Clinical Sciences, Murdoch Children's Research InstituteParkvilleVictoriaAustralia
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health SciencesUniversity of MelbourneParkvilleVictoriaAustralia
| | - David Herd
- Emergency DepartmentQueensland Children's HospitalBrisbaneQueenslandAustralia
- Child Health Research CentreUniversity of QueenslandBrisbaneQueenslandAustralia
- Mater Research InstituteBrisbaneQueenslandAustralia
| | - Meredith L. Borland
- Emergency DepartmentPerth Children's HospitalPerthAustralia
- Divisions of Emergency Medicine and PaediatricsUniversity of Western AustraliaPerthWestern AustraliaAustralia
| | - Amit Kochar
- Emergency DepartmentWomen's and Children's HospitalAdelaideSouth AustraliaAustralia
| | - Michael Zhang
- Emergency DepartmentJohn Hunter HospitalNewcastleNew South WalesAustralia
| | - Ed Oakley
- Emergency DepartmentRoyal Children's HospitalParkvilleVictoriaAustralia
- Clinical Sciences, Murdoch Children's Research InstituteParkvilleVictoriaAustralia
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health SciencesUniversity of MelbourneParkvilleVictoriaAustralia
- Department of Critical Care, Faculty of Medicine, Dentistry and Health SciencesUniversity of MelbourneParkvilleVictoriaAustralia
| | - Sandy M. Hopper
- Emergency DepartmentRoyal Children's HospitalParkvilleVictoriaAustralia
- Clinical Sciences, Murdoch Children's Research InstituteParkvilleVictoriaAustralia
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health SciencesUniversity of MelbourneParkvilleVictoriaAustralia
| | - Robert G. Berkowitz
- Clinical Sciences, Murdoch Children's Research InstituteParkvilleVictoriaAustralia
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health SciencesUniversity of MelbourneParkvilleVictoriaAustralia
- Department of OtolaryngologyRoyal Children's HospitalParkvilleVictoriaAustralia
| | - Catherine L. Wilson
- Clinical Sciences, Murdoch Children's Research InstituteParkvilleVictoriaAustralia
| | - Amanda Williams
- Emergency DepartmentRoyal Children's HospitalParkvilleVictoriaAustralia
- Clinical Sciences, Murdoch Children's Research InstituteParkvilleVictoriaAustralia
| | - Mark T. Mackay
- Clinical Sciences, Murdoch Children's Research InstituteParkvilleVictoriaAustralia
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health SciencesUniversity of MelbourneParkvilleVictoriaAustralia
- Department of NeurologyRoyal Children's HospitalParkvilleVictoriaAustralia
| | - Katherine J. Lee
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health SciencesUniversity of MelbourneParkvilleVictoriaAustralia
- Melbourne Children's Trial Centre, Clinical Epidemiology and Biostatistics UnitMurdoch Children's Research InstituteVictoriaParkvilleAustralia
| | - Stephen Hearps
- Clinical Sciences, Murdoch Children's Research InstituteParkvilleVictoriaAustralia
- Department of Critical Care, Faculty of Medicine, Dentistry and Health SciencesUniversity of MelbourneParkvilleVictoriaAustralia
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7
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Bressan S, Eapen N, Phillips N, Gilhotra Y, Kochar A, Dalton S, Cheek JA, Furyk J, Neutze J, Williams A, Hearps S, Donath S, Oakley E, Singh S, Dalziel SR, Borland ML, Babl FE. PECARN algorithms for minor head trauma: Risk stratification estimates from a prospective PREDICT cohort study. Acad Emerg Med 2021; 28:1124-1133. [PMID: 34236116 DOI: 10.1111/acem.14308] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 05/11/2021] [Accepted: 05/25/2021] [Indexed: 01/21/2023]
Abstract
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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Affiliation(s)
- Silvia Bressan
- Department of Women's and Children's Health University of Padova Padova Italy
- Clinical Sciences Murdoch Children's Research Institute Melbourne Victoria Australia
| | - Nitaa Eapen
- Clinical Sciences Murdoch Children's Research Institute Melbourne Victoria Australia
- Department of Paediatrics and Centre for Integrated Critical Care Faculty of Medicine, Dentistry and Health Sciences University of Melbourne Melbourne Victoria Australia
| | - Natalie Phillips
- Queensland Children's Hospital Brisbane Queensland Australia
- Child Health Research Centre University of Queensland Brisbane Queensland Australia
| | - Yuri Gilhotra
- Queensland Children's Hospital Brisbane Queensland Australia
| | - Amit Kochar
- Emergency Department Women's & Children's Hospital Adelaide South Australia Australia
| | - Sarah Dalton
- Emergency Department The Children's Hospital at Westmead Sydney New South Wales Australia
| | - John A. Cheek
- Clinical Sciences Murdoch Children's Research Institute Melbourne Victoria Australia
- Department of Paediatrics and Centre for Integrated Critical Care Faculty of Medicine, Dentistry and Health Sciences University of Melbourne Melbourne Victoria Australia
- Emergency Department Royal Children's Hospital Melbourne Victoria Australia
- Emergency Department Monash Medical Centre Melbourne Victoria Australia
| | - Jeremy Furyk
- Emergency Department The Townsville Hospital Townsville Queensland Australia
- Emergency Department University Hospital Geelong Geelong Victoria Australia
- School of Medicine Faculty of Health Deakin University Geelong Victoria Australia
| | - Jocelyn Neutze
- Emergency Department Kidzfirst Middlemore Hospital Auckland New Zealand
| | - Amanda Williams
- Clinical Sciences Murdoch Children's Research Institute Melbourne Victoria Australia
| | - Stephen Hearps
- Clinical Sciences Murdoch Children's Research Institute Melbourne Victoria Australia
| | - Susan Donath
- Clinical Sciences Murdoch Children's Research Institute Melbourne Victoria Australia
- Department of Paediatrics and Centre for Integrated Critical Care Faculty of Medicine, Dentistry and Health Sciences University of Melbourne Melbourne Victoria Australia
| | - Ed Oakley
- Clinical Sciences Murdoch Children's Research Institute Melbourne Victoria Australia
- Department of Paediatrics and Centre for Integrated Critical Care Faculty of Medicine, Dentistry and Health Sciences University of Melbourne Melbourne Victoria Australia
- Emergency Department Royal Children's Hospital Melbourne Victoria Australia
| | - Sonia Singh
- Clinical Sciences Murdoch Children's Research Institute Melbourne Victoria Australia
- Department of Paediatrics and Centre for Integrated Critical Care Faculty of Medicine, Dentistry and Health Sciences University of Melbourne Melbourne Victoria Australia
- Emergency Department Royal Children's Hospital Melbourne Victoria Australia
- University of California Davis Medical Center Sacramento California USA
| | - Stuart R. Dalziel
- Emergency Department Starship Children's Health Auckland New Zealand
- Departments of Surgery and Paediatrics: Child and Youth Health University of Auckland Auckland New Zealand
| | - Meredith L. Borland
- Emergency Department Perth Children's Hospital Perth Western Australia Australia
- Divisions of Emergency Medicine and Paediatrics School of Medicine University of Western Australia Perth Western Australia Australia
| | - Franz E. Babl
- Clinical Sciences Murdoch Children's Research Institute Melbourne Victoria Australia
- Department of Paediatrics and Centre for Integrated Critical Care Faculty of Medicine, Dentistry and Health Sciences University of Melbourne Melbourne Victoria Australia
- Emergency Department Royal Children's Hospital Melbourne Victoria Australia
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8
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Eapen N, Kochar A, Lyttle MD, Phillips N, Cheek JA, Furyk J, Neutze J, Bressan S, Williams A, Hearps S, Oakley E, Dalziel SR, Borland ML, Babl FE. Seizure- and syncope-related head injuries in children: A prospective PREDICT cohort study. Emerg Med Australas 2021; 33:769-771. [PMID: 34105253 DOI: 10.1111/1742-6723.13812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 05/29/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Nitaa Eapen
- Emergency Department, The Royal Children's Hospital, Melbourne, Victoria, Australia.,Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Amit Kochar
- Emergency Department, Women's and Children's Hospital, Adelaide, South Australia, Australia
| | - Mark D Lyttle
- Emergency Department, Bristol Royal Hospital for Children, Bristol, UK.,Faculty of Health and Life Sciences, University of the West of England, Bristol, UK
| | - Natalie Phillips
- Emergency Department, Queensland Children's Hospital, Brisbane, Queensland, Australia.,Child Health Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - John A Cheek
- Emergency Department, The Royal Children's Hospital, Melbourne, Victoria, Australia.,Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Emergency Department, Monash Medical Centre, Melbourne, Victoria, Australia.,Department of Paediatrics and Centre for Integrated Critical Care, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Jeremy Furyk
- Emergency Department, The Townsville Hospital, Townsville, Queensland, Australia.,Emergency Department, University Hospital Geelong, Geelong, Victoria, Australia.,School of Medicine, Faculty of Health, Deakin University, Geelong, Victoria, Australia
| | - Jocelyn Neutze
- Emergency Department, Kidz First Middlemore Hospital, Auckland, New Zealand
| | - Silvia Bressan
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Women's and Children's Health, University of Padova, Padova, Italy
| | - Amanda Williams
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Stephen Hearps
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Ed Oakley
- Emergency Department, The Royal Children's Hospital, Melbourne, Victoria, Australia.,Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics and Centre for Integrated Critical Care, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Stuart R Dalziel
- Emergency Department, Starship Children's Health, Auckland, New Zealand.,Departments of Surgery and Paediatrics: Child and Youth Health, The University of Auckland, Auckland, New Zealand
| | - Meredith L Borland
- Emergency Department, Perth Children's Hospital, Perth, Western Australia, Australia.,School of Medicine, Divisions of Emergency Medicine and Paediatrics, The University of Western Australia, Perth, Western Australia, Australia
| | - Franz E Babl
- Emergency Department, The Royal Children's Hospital, Melbourne, Victoria, Australia.,Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics and Centre for Integrated Critical Care, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
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9
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Eapen N, Borland ML, Phillips N, Kochar A, Dalton S, Cheek JA, Gilhotra Y, Neutze J, Lyttle MD, Donath S, Crowe L, Dalziel SR, Oakley E, Williams A, Hearps S, Bressan S, Babl FE. Neonatal head injuries: A prospective Paediatric Research in Emergency Departments International Collaborative cohort study. J Paediatr Child Health 2020; 56:764-769. [PMID: 31868278 DOI: 10.1111/jpc.14736] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 08/15/2019] [Accepted: 12/02/2019] [Indexed: 12/15/2022]
Abstract
AIM To characterise the causes, clinical characteristics and short-term outcomes of neonates who presented to paediatric emergency departments with a head injury. METHODS Secondary analysis of a prospective data set of paediatric head injuries at 10 emergency departments in Australia and New Zealand. Patients without neuroimaging were followed up by telephone call. We extracted epidemiological information, clinical findings and outcomes in neonates (≤28 days). RESULTS Of 20 137 children with head injuries, 93 (0.5%) occurred in neonates. These were mostly fall-related (75.2%), commonly from a care giver's arms, or due to being accidentally struck by a person/object (20.4%). There were three cases of non-accidental head injuries (3.2%). Most neonates were asymptomatic (67.7%) and many had no findings on examination (47.3%). Most neonates had a Glasgow Coma Scale 15 (89.2%) or 14 (7.5%). A total of 15.1% presented with vomiting and 5.4% were abnormally drowsy. None had experienced a loss of consciousness. The most common findings on examination were scalp haematoma (28.0%) and possible palpable skull fracture (6.5%); 8.6% underwent computed tomography brain scan and 4.3% received an ultrasound. Five of eight computed tomography scan (5.4% of neonates overall) showed traumatic brain injury and two of four (2.2% overall) had traumatic brain injury on ultrasound. Thirty-seven percent were admitted, one patient was intubated and none had neurosurgery or died. CONCLUSIONS Neonatal head injuries are rare with a mostly benign short-term outcome and are appropriate for observation. However, non-accidental injuries need to be considered.
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Affiliation(s)
- Nitaa Eapen
- Emergency Department, Royal Children's Hospital, Melbourne, Victoria, Australia.,Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Meredith L Borland
- Emergency Department, Perth Children's Hospital, Perth, Western Australia, Australia.,Schools of Medicine, Divisions of Emergency Medicine and Paediatrics, University of Western Australia, Perth, Western Australia, Australia
| | - Natalie Phillips
- Emergency Department, Queensland Children's Hospital, Brisbane, Queensland, Australia.,Child Health Research Centre, The University of Queensland, Medical Research Institute, Brisbane, Queensland, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Amit Kochar
- Emergency Department, Women's and Children's Hospital, Adelaide, South Australia, Australia
| | - Sarah Dalton
- Emergency Department, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - John A Cheek
- Emergency Department, Royal Children's Hospital, Melbourne, Victoria, Australia.,Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Emergency Department, Monash Medical Centre, Melbourne, Victoria, Australia
| | - Yuri Gilhotra
- Emergency Department, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Jocelyn Neutze
- Emergency Department, Kidzfirst Middlemore Hospital, Auckland, New Zealand
| | - Mark D Lyttle
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Emergency Department, Bristol Royal Hospital for Children, Bristol, United Kingdom.,Faculty of Health & Life Sciences, University of the West of England, Bristol, United Kingdom
| | - Susan Donath
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Louise Crowe
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Stuart R Dalziel
- Emergency Department, Starship Children's Health, Auckland, New Zealand.,Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Ed Oakley
- Emergency Department, Royal Children's Hospital, Melbourne, Victoria, Australia.,Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Amanda Williams
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Stephen Hearps
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Silvia Bressan
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Women's and Child Heath, University of Padova, Padova, Italy
| | - Franz E Babl
- Emergency Department, Royal Children's Hospital, Melbourne, Victoria, Australia.,Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
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10
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Eapen N, Davis GA, Borland ML, Phillips N, Oakley E, Hearps S, Kochar A, Dalton S, Cheek J, Furyk J, Lyttle MD, Bressan S, Crowe L, Dalziel S, Tavender E, Babl FE. Clinically important sport-related traumatic brain injuries in children. Med J Aust 2019; 211:365-366. [PMID: 31420871 DOI: 10.5694/mja2.50311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Accepted: 06/06/2019] [Indexed: 11/17/2022]
Affiliation(s)
- Nitaa Eapen
- Royal Children's Hospital, Melbourne, VIC.,Murdoch Children's Research Institute, Melbourne, VIC.,University of Melbourne, Melbourne, VIC
| | - Gavin A Davis
- Murdoch Children's Research Institute, Melbourne, VIC.,University of Melbourne, Melbourne, VIC
| | - Meredith L Borland
- Perth Children's Hospital, Perth, WA.,University of Western Australia, Perth, WA
| | - Natalie Phillips
- Queensland Children's Hospital, Brisbane, QLD.,Children's Health Research Centre, University of Queensland, Brisbane, QLD
| | - Ed Oakley
- Royal Children's Hospital, Melbourne, VIC.,Murdoch Children's Research Institute, Melbourne, VIC.,University of Melbourne, Melbourne, VIC
| | | | - Amit Kochar
- Women's and Children's Hospital, Adelaide, SA
| | | | - John Cheek
- Royal Children's Hospital, Melbourne, VIC.,Murdoch Children's Research Institute, Melbourne, VIC.,University of Melbourne, Melbourne, VIC
| | | | - Mark D Lyttle
- Murdoch Children's Research Institute, Melbourne, VIC.,Bristol Royal Hospital for Children, Bristol, United Kingdom
| | - Silvia Bressan
- Murdoch Children's Research Institute, Melbourne, VIC.,University of Padova, Padova, Italy
| | - Louise Crowe
- Murdoch Children's Research Institute, Melbourne, VIC.,University of Melbourne, Melbourne, VIC
| | - Stuart Dalziel
- Starship Children's Health, Auckland, New Zealand.,University of Auckland, Auckland, New Zealand
| | - Emma Tavender
- Murdoch Children's Research Institute, Melbourne, VIC.,University of Melbourne, Melbourne, VIC
| | - Franz E Babl
- Royal Children's Hospital, Melbourne, VIC.,Murdoch Children's Research Institute, Melbourne, VIC.,University of Melbourne, Melbourne, VIC
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