Citation

Nigrovic LE, Lee LK, Hoyle J, Stanley RM, Gorelick MH, Miskin M, Atabaki SM, Dayan PS, Holmes JF, Kuppermann N. Arch. Pediatr. Adolesc. Med. 2012; 166(4): 356-361.

Affiliation

Children's Hospital-Boston, Harvard Medical School, Boston, Massachusetts (Drs Nigrovic and Lee); Division of Emergency Medicine, Helen DeVos Children's Hospital, Michigan State University School of Medicine, Grand Rapids (Dr Hoyle); Department of Emergency Medicine, University of Michigan Health System, University of Michigan, Ann Arbor (Dr Stanley); Division of Emergency Medicine, Children's Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee (Dr Gorelick); University of Utah School of Medicine, Salt Lake City (Ms Miskin); Departments of Pediatrics and Emergency Medicine, Children's National Medical Center, George Washington University School of Medicine, Washington, DC (Dr Atabaki); Department of Pediatrics, Morgan Stanley Children's Hospital of New York-Presbyterian, Columbia University College of Physicians and Surgeons, New York, New York (Dr Dayan); and Departments of Emergency Medicine (Drs Holmes and Kuppermann) and Pediatrics (Dr Kuppermann), School of Medicine, University of California-Davis Medical Center, Davis.

Copyright

(Copyright © 2012, American Medical Association)

DOI

10.1001/archpediatrics.2011.1156

PMID

22147762

Abstract

OBJECTIVE: To determine the prevalence of clinically important traumatic brain injuries (TBIs) with severe injury mechanisms in children with minor blunt head trauma but with no other risk factors from the Pediatric Emergency Care Applied Research Network (PECARN) TBI prediction rules (defined as isolated severe injury mechanisms). DESIGN: Secondary analysis of a large prospective observational cohort study. SETTING: Twenty-five emergency departments participating in the PECARN. Patients  Children with minor blunt head trauma and Glasgow Coma Scale scores of at least 14. Intervention  Treating clinicians completed a structured data form that included injury mechanism (severity categories defined a priori). MAIN OUTCOME MEASURES: Clinically important TBIs were defined as intracranial injuries resulting in death, neurosurgical intervention, intubation for more than 24 hours, or hospital admission for at least 2 nights. We investigated the rate of clinically important TBIs in children with either severe injury mechanisms or isolated severe injury mechanisms. RESULTS: Of the 42 412 patients enrolled in the overall study, 42 099 (99%) had injury mechanisms recorded, and their data were included for analysis. Of all study patients, 5869 (14%) had severe injury mechanisms, and 3302 (8%) had isolated severe injury mechanisms. Overall, 367 children had clinically important TBIs (0.9%; 95% CI, 0.8%-1.0%). Of the 1327 children younger than 2 years with isolated severe injury mechanisms, 4 (0.3%; 95% CI, 0.1%-0.8%) had clinically important TBIs, as did 12 of the 1975 children 2 years or older (0.6%; 95% CI, 0.3%-1.1%). CONCLUSION: Children with isolated severe injury mechanisms are at low risk of clinically important TBI, and many do not require emergent neuroimaging.

Language: en