Can the “important brain injury criteria” predict neurosurgical intervention in mild traumatic brain injury? A validation study

Lessard, Justine; Cournoyer, Alexis; Piette, Éric; Paquet, Jean; Daoust, Raoul

doi:10.1016/j.ajem.2019.05.043

Cited by 3 publications

(2 citation statements)

References 33 publications

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“…26,27 However, most studies investigating clinical decision rules in mTBI include only adult patients. [28][29][30][31] The pediatric mTBI patient is different from an adult in many ways, including mechanism of injury, time taken for the injury to become noticed, difficulty and variability in assessment of GCS, and clinical management. Hence a clinical decision rule designed for use in an adult patient may not have the same utility in a pediatric population.…”

Section: Discussionmentioning

confidence: 99%

“…Clinical decision rules, such as a point scores tool, are useful to streamline such decision making 26,27. However, most studies investigating clinical decision rules in mTBI include only adult patients 28–31. The pediatric mTBI patient is different from an adult in many ways, including mechanism of injury, time taken for the injury to become noticed, difficulty and variability in assessment of GCS, and clinical management.…”

Section: Discussionmentioning

confidence: 99%

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Utility and Predictive Value of CHIIDA Score in Pediatric Traumatic Brain Injury: A Prospective Observational Study

Jain

Karnik²,

Kotwani³

2020

Journal of Neurosurgical Anesthesiology

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Background: The Children's Intracranial Injury Decision Aid (CHIIDA) is a tool designed to stratify children with mild traumatic brain injury (mTBI). The aim of this study was to assess the utility and predictive value of CHIIDA in the assessment of the need for intensive care unit (ICU) admission in pediatric patients with mTBI.Methods: This prospective observational study included 425 children below 18 years of age admitted to the ICU of a tertiary care hospital with mTBI (Glasgow Coma Scale 13 to 15). The primary outcome was the composite of neurosurgical intervention, intubation for more than 24 hours for TBI, or death from TBI. Sensitivity, specificity, predictive values and likelihood ratios were calculated at CHIIDA scores 0 and 2.Results: Among 425 children with mTBI, 210 (49%) had a CHIIDA score 0, 16 (4%) scored 2 points, and 199 (47%) scored more than 2 points. Thirty-six (8.47%) patients experienced the primary outcome, and there were 3 deaths. A cutoff CHIIDA > 0 to admit to ICU had a sensitivity of 97.22% (95% confidence interval [CI], 97.05%-97.39%) and a negative predictive value of 99.54% (95% CI, 99.50%-99.56%). A cutoff of score > 2 had a sensitivity of 97.22% (95% CI, 97.05%-97.39%), and negative predictive value of 99.56% (95% CI, 99.54%-99.59%). The post-test probability at cutoff score of 0 and 2 was 16.65% and 16.27%, respectively.Conclusions: CHIIDA score does not serve as reliable triage tool for identifying children with TBI who do not require ICU admission.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Utility and Predictive Value of CHIIDA Score in Pediatric Traumatic Brain Injury: A Prospective Observational Study

Jain

Karnik²,

Kotwani³

2020

Journal of Neurosurgical Anesthesiology

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What are the demographic and clinical differences between those older adults with traumatic brain injury who receive a neurosurgical intervention to those that do not? A systematic literature review with narrative synthesis

et al. 2022

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A Biomarker for Concussion: The Good, the Bad, and the Unknown

Reece

Milone

Wang

et al. 2019

The Journal of Applied Laboratory Medicine

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Background Traumatic brain injury (TBI) is a significant cause of morbidity, mortality, and disability in the US, with >2.8 million patients presenting to the emergency department (ED) annually. However, the diagnosis of TBI is challenging and presents a number of difficulties, particularly at the mildest end of the spectrum: concussion. A number of groups have researched biomarkers to aid in the evaluation of TBI, and most recently in 2018 the Food and Drug Administration approved a new blood-based immunoassay biomarker using ubiquitin carboxyl hydrolase L1 and glial fibrillary acidic protein to aid in head computed tomography (CT) triage. Content This review clarifies the practical challenges in assessing and implementing a new blood biomarker. It then examines the clinical context and need, as well as the evidence used to validate this new immunoassay. Summary Concussion is a multifaceted diagnosis with a need for biomarkers to assist in diagnostic and prognostic assessment. Recent articles in the lay press have revealed misunderstanding about the function of this new test, expressing hopes that this biomarker serves patients at the mildest end of the spectrum and is useful for athletes and children. None of these assumptions are correct, as this biomarker has been evaluated in patients only at the moderate end of the spectrum and has been validated only in adults presenting to the ED who have already been triaged to receive head CT, not in athletes or children. The next steps for this assay should consider clinical work flow and clarifying its intended use, including integration with existing triage methods, and validating the assay for a broader population.

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Can the “important brain injury criteria” predict neurosurgical intervention in mild traumatic brain injury? A validation study

Cited by 3 publications

References 33 publications

Utility and Predictive Value of CHIIDA Score in Pediatric Traumatic Brain Injury: A Prospective Observational Study

Utility and Predictive Value of CHIIDA Score in Pediatric Traumatic Brain Injury: A Prospective Observational Study

What are the demographic and clinical differences between those older adults with traumatic brain injury who receive a neurosurgical intervention to those that do not? A systematic literature review with narrative synthesis

A Biomarker for Concussion: The Good, the Bad, and the Unknown

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