A Novel Decision-Support Tool (IniCT Score) for Repeat Head Computed Tomography in Pediatric Mild Traumatic Brain Injury

Hanalıoğlu, Şahin; Hanalioğlu, Damla; Elbir, Cagri; Gülmez, Ahmet; Şahin, Ömer Selçuk; Şahin, Balkan; Türkoğlu, Mehmet Erhan; Kertmen, Hüseyin Hayri

doi:10.1016/j.wneu.2022.05.103

Cited by 3 publications

(6 citation statements)

References 25 publications

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“…Nearly a quarter of children with isolated epidural hemorrhage, isolated subdural hemorrhage, and multiple hemorrhages on initial neuroimaging in our sample developed our primary outcome. This finding is consistent with previous literature 19,20 revealing a percentage of children with these initial neuroradiographic findings will require interventions or deteriorate and are therefore considered higher risk. However, within these hemorrhage subtypes, most do not require interventions or deteriorate.…”

Section: Discussionsupporting

confidence: 93%

“…Of the children with deterioration, most sustained nonaccidental injuries, 2 deteriorated within 6 hours of ED arrival, and 1 deteriorated later but was identified early in the ED course as higher risk by clinicians due to multiple hemorrhages on initial neuroimaging. Our findings support previous literature 17,19,20 that risk stratification of children with nonsevere tICH is achievable and lend further support that a broader definition of low risk is possible with additional research in this domain.…”

Section: Discussionsupporting

confidence: 90%

“…Neurosurgical interventions are relatively uncommon, although previous studies have reported varying rates and timing of these interventions. [2][3][4][5][6][7][8][9][10][11]13,[16][17][18][19][20] Data on critical medical interventions such as hyperosmotic agent administration and intubation are more limited, 12,19 as are data on other forms of clinically important deterioration, such as a decline in GCS resulting in a floor to intensive care unit (ICU) transfer. 20 A comprehensive understanding of both the rates and timing of these outcomes will improve accurate risk stratification.…”

mentioning

confidence: 99%

“…[2][3][4][5][6][7][8][9][10][11]13,[16][17][18][19][20] Data on critical medical interventions such as hyperosmotic agent administration and intubation are more limited, 12,19 as are data on other forms of clinically important deterioration, such as a decline in GCS resulting in a floor to intensive care unit (ICU) transfer. 20 A comprehensive understanding of both the rates and timing of these outcomes will improve accurate risk stratification. Therefore, our objectives were to report rates and timing of clinically important tICH, including immediate ED interventions and deterioration, in children with nonsevere tICH and to describe associated clinical and neuroradiographic characteristics and outcomes.…”

mentioning

confidence: 99%

“…A likely source for this institutional and practitioner variability in management relates to uncertainty in the rates and timing of clinically important tICH, including lesions requiring immediate ED interventions or that result in delayed clinical deterioration due to hemorrhage progression. Neurosurgical interventions are relatively uncommon, although previous studies have reported varying rates and timing of these interventions 2–11,13,16–20 . Data on critical medical interventions such as hyperosmotic agent administration and intubation are more limited, 12,19 as are data on other forms of clinically important deterioration, such as a decline in GCS resulting in a floor to intensive care unit (ICU) transfer 20 .…”

mentioning

confidence: 99%

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Critical Emergency Department Interventions and Clinical Deterioration in Children With Nonsevere Traumatic Intracranial Hemorrhage

Chaudhari,

Durham,

Bachur

et al. 2023

Pediatr Emer Care

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Objective Substantial practice variation exists in the management of children with nonsevere traumatic intracranial hemorrhage (tICH). A comprehensive understanding of rates and timing of clinically important tICH, including critical interventions and deterioration, along with associated clinical and neuroradiographic characteristics, will inform accurate risk stratification. Methods We conducted a single-center retrospective cohort study of children aged younger than 18 years evaluated in the emergency department (ED) from May 1, 2014 to February 28, 2020 with tICH and initial Glasgow Coma Scale (GCS) score of higher than 8. We determined rates of clinically important tICH after injury and within 96 hours of ED arrival, defined as immediate ED interventions (intubation, hyperosmotic agents, or neurosurgery within 4 hours of arrival) or clinically important deterioration (signs/symptoms with change in management). Associations between outcome and clinical and neuroradiographic characteristics were calculated using individual logistic regression models. Results Our sample included 135 children. Clinically important tICH was observed in 13.3% (n = 18); 9 (6.7%) underwent immediate ED interventions and 9 (6.7%) developed deterioration. Most (93.3%, n = 127) presented with an initial GCS ≥ 14, including all children who later deteriorated. Initial GCS (P = 0.001) and nonaccidental trauma (P = 0.024) mechanism were associated with the outcome. None of the 71 (52.6%) children with initial GCS ≥ 14, isolated, nonepidural hemorrhage after accidental injury developed clinically important tICH. Conclusions Clinically important tICH occurred in 13% of children with nonsevere tICH, and 7% of children who did not undergo immediate ED interventions later deteriorated, all of whom had an initial GCS ≥ 14. However, a subgroup of children was identified as low risk based on clinical and neuroradiographic characteristics.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionsupporting

confidence: 90%

mentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Critical Emergency Department Interventions and Clinical Deterioration in Children With Nonsevere Traumatic Intracranial Hemorrhage

Chaudhari,

Durham,

Bachur

et al. 2023

Pediatr Emer Care

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Hospitalization rates and radiological findings in infants with head trauma after a fall

Sukun

Önal

2023

Online Türk Sağlık Bilimleri Dergisi

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Objective: The study aimed to determine the necessity of performing CT scans in infants with head trauma as a result of falls because of the concerns regarding radiation exposure by evaluating the hospitalization rates. Methods: The present study included 1060 patients who underwent cranial CT in the emergency department owing to a pediatric fall between 2018 and 2022. One patient who refused treatment and one traffic accident case were excluded from the study. Skull fractures and their characteristics and associated skin findings and intracranial hemorrhage on CT scans and patients demographic features (age & sex) and medical history, hospitalization rates were investigated. Results: Of the 1058 patients with brain trauma who presented to the emergency department in the secondary care center, fractures was detected in only 28 patients. Of these patients, 1.8% were treated as inpatients. Subdural hematomas and epidural hematomas were detected in 10.7% (n = 3) and 7.1% (n = 2) of patients with fractures, respectively. Furthermore, subdural hematomas and epidural hematomas were detected in 0.3% and 0.2% of trauma admissions, respectively. Conclusion: In conclusion, positive CT findings and a low percentage of patients requiring hospitalization stand out in the patients examined. Therefore, care should be taken when requesting tomography between the ages of 0-2. Keywords: skull fracture, infant, head trauma, hospitalization rates, fall

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Electric Scooter Falls: The 2023–2024 Experience in the Clinical Emergency Children’s Hospital in Galați

Popescu,

Marina,

Popescu

et al. 2024

Clinics and Practice

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(1) Introduction: Since electric scooters were launched in 2017, they have become increasingly popular worldwide and a cause of childhood trauma. (2) Case reports: This paper has a double-fold purpose: it reports two cases of epidural hematomas and compares them with electric scooter-related head trauma in the literature. An overview of the literature on this topic was performed to make such a comparison. Our cases are one of almost 52 cm3 and one of 129 cm3, both in two eight-year-olds. (3) Discussion: Although usually mild, traumatic brain injuries following e-scooter falls can also be moderate and severe. Reduced helmet use, high speed, and a lack of experience are the perfect set-up for potential severe injuries. Intracranial bleeds are not frequent, and epidural hematomas are rare in such cases, but they can significantly impact the individual, community, and healthcare system. No other medium- or large-sized epidural hematomas were reported in children sustaining electric scooter-related head trauma. (4) Conclusions: Our review parallels the literature and our hospital’s experience. Although there are both similarities and discrepancies between our cases and the literature, mild trauma should not be disregarded, for it may hide serious complications requiring immediate surgery.

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A Novel Decision-Support Tool (IniCT Score) for Repeat Head Computed Tomography in Pediatric Mild Traumatic Brain Injury

Cited by 3 publications

References 25 publications

Critical Emergency Department Interventions and Clinical Deterioration in Children With Nonsevere Traumatic Intracranial Hemorrhage

Critical Emergency Department Interventions and Clinical Deterioration in Children With Nonsevere Traumatic Intracranial Hemorrhage

Hospitalization rates and radiological findings in infants with head trauma after a fall

Electric Scooter Falls: The 2023–2024 Experience in the Clinical Emergency Children’s Hospital in Galați

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