Citation

Azim A, Jehan FS, Rhee P, O'Keeffe T, Tang A, Vercruysse G, Kulvatunyou N, Latifi R, Joseph B. J. Trauma Acute Care Surg. 2017; 83(6): 1200-1204.

Affiliation

Department of Surgery, Division of Trauma, Critical Care, Burns, and Acute Care Surgery; University of Arizona.

Copyright

(Copyright © 2017, Lippincott Williams and Wilkins)

DOI

10.1097/TA.0000000000001611

PMID

28590352

Abstract

INTRODUCTION: Brain Injury Guidelines (BIG) were developed to reduce over utilization of Neurosurgical Consultation (NC) as well as CT imaging. Currently, BIG have been successfully applied to adult populations, but the value of implementing these guidelines among pediatric patients remains unassessed. Therefore, the aim of this study was to evaluate the established BIG (BIG-1 category) for managing pediatric traumatic brain injury (TBI) patients with intracranial hemorrhage (ICH) without neurosurgical consultation (No-NC).

METHODS: We prospectively implemented the BIG-1 category (normal neurological exam, ICH ≤ 4mm limited to 1 location, no skull fracture) to identify pediatric TBI patients (age ≤ 21years) that were to be managed No-NC. Propensity score matching was performed to match these No-NC patients to a similar cohort of patients managed with NC before the implementation of BIG in a 1:1 ratio for demographics, severity of injury, and type as well as size of ICH. Our primary outcome measure was need for neurosurgical intervention.

RESULTS: A total of 405 pediatric TBI patients were enrolled, of which 160 (80: NC and 80: No-NC) were propensity score matched. The mean age was 9.03 ± 7.47 years, 62.1% (n=85) were male, the median Glasgow Coma Scale (GCS) was 15 [13-15], and the median head-abbreviated injury scale (AIS) was 2 [2-3]. A sub-analysis based on stratifying patients by age groups showed a decreased in the use of RHCT (p=0.02) in the No-NC group, with no difference in progression (p=0.34) and the need for neurosurgical intervention (p=0.9) compared to the NC group.

CONCLUSION: The BIG can be safely and effectively implemented in pediatric TBI patients. Reducing repeat head CT in pediatric patients has long-term sequelae. Likewise, adhering to the guidelines helps in reducing radiation exposure across all age groups. LEVEL OF EVIDENCE: Therapeutic/care management, level III.

Language: en