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WHAT'S KNOWN ON THIS SUBJECT:Emergency-department observation of children with minor blunt head trauma for symptom progression before making a decision regarding computed tomography may decrease computed tomography use. The actual impact of this strategy on computed tomography use and clinical outcomes, however, is unknown. WHAT THIS STUDY ADDS:Clinicians currently observe some children with head trauma before deciding whether to obtain a cranial computed tomography scan. Patients who were observed had a significantly lower rate of overall cranial computed tomography use after adjusting for markers of head injury severity.abstract OBJECTIVE: Children with minor blunt head trauma often are observed in the emergency department before a decision is made regarding computed tomography use. We studied the impact of this clinical strategy on computed tomography use and outcomes. METHODS:We performed a subanalysis of a prospective multicenter observational study of children with minor blunt head trauma. Clinicians completed case report forms indicating whether the child was observed before making a decision regarding computed tomography. We defined clinically important traumatic brain injury as an intracranial injury resulting in death, neurosurgical intervention, intubation for longer than 24 hours, or hospital admission for 2 nights or longer. To compare computed tomography rates between children observed and those not observed before a decision was made regarding computed tomography use, we used a generalized estimating equation model to control for hospital clustering and patient characteristics. RESULTS: Of 42 412 children enrolled in the study, clinicians noted if the patient was observed before making a decision on computed tomography in 40 113 (95%). Of these, 5433 (14%) children were observed. The computed tomography use rate was lower in those observed than in those not observed (31.1% vs 35.0%; difference: Ϫ3.9% [95% confidence interval: Ϫ5.3 to Ϫ2.6]), but the rate of clinically important traumatic brain injury was similar (0.75% vs 0.87%; difference: Ϫ0.1% [95% confidence interval: Ϫ0.4 to 0.1]). After adjustment for hospital and patient characteristics, the difference in the computed tomography use rate remained significant (adjusted odds ratio for obtaining a computed tomography in the observed group: 0.53 [95% confidence interval: 0.43-0.66] Minor blunt head trauma is a common reason for children to present to the emergency department, 1 although the prevalence of traumatic brain injury (TBI) is low. [2][3][4][5] Cranial computed tomography (CT) is the reference standard for emergently diagnosing TBI in children. Clinicians frequently include an emergent CT in the diagnostic evaluation of children with nontrivial blunt head trauma who present to the emergency department. Furthermore, emergency-department utilization of cranial CT has increased substantially over the last decade. 6,7 Cranial CT is not without risks. Most important are the long-term risks of lethal malignancy induced from the ionizing rad...

BACKGROUND AND OBJECTIVE: Children and adolescents with minor blunt head trauma and isolated skull fractures are often admitted to the hospital. The objective of this study was to describe the injury circumstances and frequency of clinically important neurologic complications among children with minor blunt head trauma and isolated linear skull fractures.

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Objective: The objective was to compare the accuracy of the pediatric Glasgow Coma Scale (GCS) score in preverbal children to the standard GCS score in older children for identifying those with traumatic brain injuries (TBIs) after blunt head trauma.Methods: This was a planned secondary analysis of a large prospective observational multicenter cohort study of children with blunt head trauma. Clinical data were recorded onto case report forms before computed tomography (CT) results or clinical outcomes were known. The total and component GCS scores were assigned by the physician at initial emergency department evaluation. The pediatric GCS was used for children <2 years old and the standard GCS for those ≥2 years old. Outcomes were TBI visible on CT and clinically important TBI (ciTBI), defined as death from TBI, neurosurgery, intubation for more than 24 hours for the head injury, or hospitalization for 2 or more nights for the head injury in association with TBI on CT. We compared the areas under the receiver operating characteristic (ROC) curves between age cohorts for the association of GCS and the TBI outcomes.