Pediatric Accidental Traumatic Brain Injury: Evidence-Based Emergency Imaging

Kadom, Nadja; Alvarado, Enrique; Medina, L. Santiago

doi:10.1007/978-3-319-67066-9_6

Cited by 2 publications

(2 citation statements)

References 41 publications

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“…The CHALICE rule applies to a broad population of head injuries of any severity, the PECARN rule was developed for minor head injuries only and the CATCH rule focused on a group of patients with specific signs or symptoms [59]. The PECARN rule is the most validated [37], and has the best sensitivity while the CHALICE rule has the best specificity [66, 91, 92]. Compared to senior, experienced, and high accuracy emergency physicians, the implementation of PECARN, CATCH or CHALICE rules have a potential to increase the CT rates with limited potential to increase the accuracy of detecting clinically important TBI [93].…”

Section: Discussionmentioning

confidence: 99%

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Grading and assessment of clinical predictive tools for paediatric head injury: a new evidence-based approach

Khalifa

Gallego

2019

BMC Emerg Med

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Background Many clinical predictive tools have been developed to diagnose traumatic brain injury among children and guide the use of computed tomography in the emergency department. It is not always feasible to compare tools due to the diversity of their development methodologies, clinical variables, target populations, and predictive performances. The objectives of this study are to grade and assess paediatric head injury predictive tools, using a new evidence-based approach, and to provide emergency clinicians with standardised objective information on predictive tools to support their search for and selection of effective tools. Methods Paediatric head injury predictive tools were identified through a focused review of literature. Based on the critical appraisal of published evidence about predictive performance, usability, potential effect, and post-implementation impact, tools were evaluated using a new framework for grading and assessment of predictive tools (GRASP). A comprehensive analysis was conducted to explain why certain tools were more successful. Results Fourteen tools were identified and evaluated. The highest-grade tool is PECARN; the only tool evaluated in post-implementation impact studies. PECARN and CHALICE were evaluated for their potential effect on healthcare, while the remaining 12 tools were only evaluated for predictive performance. Three tools; CATCH, NEXUS II, and Palchak, were externally validated. Three tools; Haydel, Atabaki, and Buchanich, were only internally validated. The remaining six tools; Da Dalt, Greenes, Klemetti, Quayle, Dietrich, and Güzel did not show sufficient internal validity for use in clinical practice. Conclusions The GRASP framework provides clinicians with a high-level, evidence-based, comprehensive, yet simple and feasible approach to grade, compare, and select effective predictive tools. Comparing the three main tools which were assigned the highest grades; PECARN, CHALICE and CATCH, to the remaining 11, we find that the quality of tools’ development studies, the experience and credibility of their authors, and the support by well-funded research programs were correlated with the tools’ evidence-based assigned grades, and were more influential, than the sole high predictive performance, on the wide acceptance and successful implementation of the tools. Tools’ simplicity and feasibility, in terms of resources needed, technical requirements, and training, are also crucial factors for their success. Electronic supplementary material The online version of this article (10.1186/s12873-019-0249-y) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

“…Despite that CT is the imaging modality of choice in the ED, because of availability and speed, however, magnetic resonance imaging is recently becoming the preferred modality in children. This would change predictive tools’ comparability and priority for recommendation, where further research is required [92].…”

Section: Discussionmentioning

confidence: 99%

Grading and assessment of clinical predictive tools for paediatric head injury: a new evidence-based approach

Khalifa

Gallego

2019

BMC Emerg Med

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Utility of brain imaging in pediatric patients with a suspected accidental spinal injury but no brain injury-related symptoms

Sirén,

Nyman,

Syvänen

et al. 2024

Childs Nerv Syst

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Purpose Imaging is the gold standard in diagnosing traumatic brain injury, but unnecessary scans should be avoided, especially in children and adolescents. Clinical decision-making rules often help to distinguish the patients who need imaging, but if spinal trauma is suspected, concomitant brain imaging is often conducted. Whether the co-occurrence of brain and spine injuries is high enough to justify head imaging in patients without symptoms suggesting brain injury is unknown. Objective This study aims to assess the diagnostic yield of brain MRI in pediatric patients with suspected or confirmed accidental spinal trauma but no potential brain injury symptoms. Methods We retrospectively reviewed the medical and imaging data of pediatric patients (under 18 years old) who have undergone concomitant MRI of the brain and spine because of acute spinal trauma in our emergency radiology department over a period of 8 years. We compared the brain MRI findings in patients with and without symptoms suggesting brain injury and contrasted spine and brain MRI findings. Results Of 179 patients (mean age 11.7 years, range 0–17), 137 had symptoms or clinical findings suggesting brain injury, and 42 did not. None of the patients without potential brain injury symptoms had traumatic findings in brain MRI. This finding also applied to patients with high-energy trauma (n = 47) and was unrelated to spinal MRI findings. Conclusion Pediatric accidental trauma patients with suspected or confirmed spine trauma but no symptoms or clinical findings suggesting brain injury seem not to benefit from brain imaging.

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Pediatric Accidental Traumatic Brain Injury: Evidence-Based Emergency Imaging

Cited by 2 publications

References 41 publications

Grading and assessment of clinical predictive tools for paediatric head injury: a new evidence-based approach

Grading and assessment of clinical predictive tools for paediatric head injury: a new evidence-based approach

Utility of brain imaging in pediatric patients with a suspected accidental spinal injury but no brain injury-related symptoms

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