Italian guidelines on the assessment and management of pediatric head injury in the emergency department

Dalt, Liviana Da; Parri, Niccolò; Amigoni, Angela; Nocerino, Agostino; Selmin, Francesca; Manara, Renzo; Perretta, Paola; Vardeu, M. P.; Bressan, Silvia

doi:10.1186/s13052-017-0442-0

Cited by 47 publications

(54 citation statements)

References 230 publications

(311 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In the paediatric head injury population, the decision regarding whether to perform CT depends mostly on the experience of the treating emergency physician. Physician experience is the key factor determining the management of paediatric patients with head injuries, although current guidelines are available for the treatment of mild TBI in children [ 11 , 12 ]. These guidelines do not advocate the use of S100B in paediatric patients, as the number of paediatric studies is insufficient.…”

Section: Introductionmentioning

confidence: 99%

Serum S100B Levels Can Predict Computed Tomography Findings in Paediatric Patients with Mild Head Injury

Kelmendi

Morina

Mekaj

et al. 2018

BioMed Research International

View full text Add to dashboard Cite

Introduction Traumatic brain injuries (TBIs) are very common in paediatric populations, in which they are also a leading cause of death. Computed tomography (CT) overuse in these populations results in ionization radiation exposure, which can lead to lethal malignancies. The aims of this study were to investigate the accuracy of serum S100B levels with respect to the detection of cranial injury in children with mild TBI and to determine whether decisions regarding the performance of CT can be made based on biomarker levels alone. Materials and Methods This was a single-center prospective cohort study that was carried out from December 2016 to December 2017. A total of 80 children with mild TBI who met the inclusion criteria were included in the study. The patients were between 2 and 16 years of age. We determined S100B protein levels and performed head CTs in all the patients. Results Patients with cranial injury, as detected by CT, had higher S100B protein levels than those without cranial injury (p < 0.0001). We found that patients with cranial injury (head CT+) had higher mean S100B protein levels (0.527 μg L−1, 95% confidence interval (CI) 0.447–0.607 μg L−1) than did patients without cranial injury (head CT−) (0.145 μg L−1, 95% CI 0.138–0.152 μg L−1). Receiver operating characteristic (ROC) curve analysis clearly showed that S100B protein levels differed between patients with and without cranial injury at 3 hours after TBI (AUC = 0.893, 95% CI 0.786–0.987, p = 0.0001). Conclusion Serum S100B levels cannot replace clinical examinations or CT as tools for identifying paediatric patients with mild head injury; however, serum S100B levels can be used to identify low-risk patients to prevent such patients from being exposed to radiation unnecessarily.

show abstract

Section: Introductionmentioning

confidence: 99%

Serum S100B Levels Can Predict Computed Tomography Findings in Paediatric Patients with Mild Head Injury

Kelmendi

Morina

Mekaj

et al. 2018

BioMed Research International

View full text Add to dashboard Cite

show abstract

“…However, its role as a screening tool to risk stratify patients for TBI in the era of high-quality head injury prediction rules remains to be clarified. However, clinicians may also be reluctant to miss a skull fracture, as its detection assists in informing families on prevention of reinjury, as the skull surrounding a fracture is at risk of further trauma 31…”

Section: Discussionmentioning

confidence: 99%

Traumatic brain injury in young children with isolated scalp haematoma

Bressan

Kochar

Oakley³

et al. 2019

Arch Dis Child

Self Cite

View full text Add to dashboard Cite

ObjectiveDespite high-quality paediatric head trauma clinical prediction rules, the management of otherwise asymptomatic young children with scalp haematomas (SH) can be difficult. We determined the risk of intracranial injury when SH is the only predictor variable using definitions from the Pediatric Emergency Care Applied Research Network (PECARN) and Children’s Head Injury Algorithm for the Prediction of Important Clinical Events (CHALICE) head trauma rules.DesignPlanned secondary analysis of a multicentre prospective observational study.SettingTen emergency departments in Australia and New Zealand.PatientsChildren <2 years with head trauma (n=5237).InterventionsWe used the PECARN (any non-frontal haematoma) and CHALICE (>5 cm haematoma in any region of the head) rule-based definition of isolated SH in both children <1 year and <2 years.Main outcome measuresClinically important traumatic brain injury (ciTBI; ie, death, neurosurgery, intubation >24 hours or positive CT scan in association with hospitalisation ≥2 nights for traumatic brain injury).ResultsIn children <1 year with isolated SH as per PECARN rule, the risk of ciTBI was 0.0% (0/109; 95% CI 0.0% to 3.3%); in those with isolated SH as defined by the CHALICE, it was 20.0% (7/35; 95% CI 8.4% to 36.9%) with one patient requiring neurosurgery. Results for children <2 years and when using rule specific outcomes were similar.ConclusionsIn young children with SH as an isolated finding after head trauma, use of the definitions of both rules will aid clinicians in determining the level of risk of ciTBI and therefore in deciding whether to do a CT scan.Trial registration numberACTRN12614000463673.

show abstract

“…Children with two or fewer PECARN risk factors are recommended for observation for the development of any signs or symptoms of intracranial injury. In Trieste, an adapted PECARN guideline is employed to aid clinicians in their management decisions for minor head injury patients (Table 4), in accordance with national guidelines regarding pediatric head injury management [14].…”

Section: Discussionmentioning

confidence: 99%

“…Some of these include: the U.S. Pediatric Emergency Care Applied Research Network (PECARN), [11] the United Kingdom’s Children’s Head Injury Algorithm for the Prediction of Important Clinical Events (CHALICE), [12] and the Canadian Assessment of Tomography for Childhood Head Injury (CATCH) [13]. In Italy, the Italian Society of Pediatric Emergency Medicine (SIMEUP) and the Italian Society of Pediatrics (SIP) have drafted a national set of guidelines for the management of pediatric head injury [14]. As international consensus on pediatric head trauma management has not been reached, these guidelines are utilized by different hospitals and trauma care facilities internationally to aid in managing pediatric head trauma patients [15–19].…”

Section: Introductionmentioning

confidence: 99%

Comparison of minor head trauma management in the emergency departments of a United States and Italian Children’s hospital

et al. 2019

View full text Add to dashboard Cite

BackgroundPediatric head trauma management varies between emergency departments globally. Here we aim to compare the pediatric minor head trauma management between a US and Italian hospital.MethodsWe conducted a retrospective chart review of children 0–18 years old presenting after minor head trauma (Glasgow Coma Scale 14–15) from two emergency departments, in Boston, Massachusetts, United States and Trieste, Italy, between January and December 2013. Frequencies of demographic, clinical, and management characteristic were calculated. We compared rate ratios for characteristics of patients receiving cranial computed tomography (CT) scans between the two populations.ResultsThere were 1783 patients in Boston, Massachusetts and 183 patients in Trieste, Italy. Patients in Boston had more reported neurologic symptoms (61.2%) than in Trieste (6%) (p < 0.001). More CT scans were ordered on the patients in Boston (17.3% vs. 6.6%) (p < 0.001), while more children were hospitalized in Trieste (55.7% vs. 8.6%) (p < 0.001). Patients with neurological symptoms more commonly had a CT scan in Trieste (45.5%) than in Boston (23.5%) (RR 0.52, 95% CI 0.27, 1.00), while more patients without neurological symptoms had CTs in Boston (7.5%) than in Trieste (4.1%) (RR 1.85, 95% CI 0.86, 4.00). Assignment of triage levels and definitions of head injury severity varied considerably between the two hospitals, resulting in dissimilar populations presenting to the two hospitals, and thus, differences in the management of these children.ConclusionThe population of head trauma patients and the management of pediatric minor head trauma differs between Boston and Trieste, with a preference for CT scans in Boston and a preference for hospitalization in Trieste. Clinical guidelines used at each institution likely lead to this variation in care influenced by the different patient populations and institutional resources.

show abstract

Italian guidelines on the assessment and management of pediatric head injury in the emergency department

Cited by 47 publications

References 230 publications

Serum S100B Levels Can Predict Computed Tomography Findings in Paediatric Patients with Mild Head Injury

Serum S100B Levels Can Predict Computed Tomography Findings in Paediatric Patients with Mild Head Injury

Traumatic brain injury in young children with isolated scalp haematoma

Comparison of minor head trauma management in the emergency departments of a United States and Italian Children’s hospital

Contact Info

Product

Resources

About