Pediatric Mild Traumatic Brain Injury: Who Can Be Managed at a Non-pediatric Trauma Center Hospital? A Systematic Review of the Literature

Keane, Olivia A.; Escobar, Mauricio A.; Neff, Lucas P.; Mitchell, Ian C.; Chern, Joshua J.; Santore, Matthew T.

doi:10.1177/00031348211050804

Cited by 7 publications

(1 citation statement)

References 26 publications

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“…Each year, 37,200 children in the United States of America sustain severe brain trauma [7]. The total annual pediatric brain trauma incidence has been estimated at 475,000 [8]. Most traumatic brain injuries (80-90%) are of low severity, with a Glasgow Coma Scale (GCS) score of 13-15 [9,10].…”

Section: Introductionmentioning

confidence: 99%

Post-Traumatic Stress as a Psychological Effect of Mild Head Injuries in Children

et al. 2023

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Background: Head trauma is one of the most common pediatric emergencies. While the psychological effects of severe head injuries are well studied, the psychological consequences of mild head injuries often go overlooked. Head injuries with a Glasgow Coma Scale score of 13–15, with symptoms such as headache, vomiting, brief loss of consciousness, transient amnesia, and absence of focal neurological signs, are defined as mild. The aim of this study is to evaluate the stress of children with mild head injuries and their parents’ relevant perception during the early post-traumatic period. Methods: This is a prospective cross-sectional study on a cohort of children with mild head injuries and their parents. Two questionnaires were implemented, the Child Trauma Screening Questionnaire (CTSQ) which was compiled by the children, and the Children’s Revised Impact of Event Scale (CRIES-13), compiled by their parents. Both questionnaires are widely used and reliable. The first presents an excellent predictive ability in children with a risk of post-traumatic stress disorder, while the second is a weighted self-completed detecting instrument for the measurement of post-traumatic stress in children and adolescents, with a detailed evaluation of their reactions to the traumatic incident. The participants responded one week and one month after the traumatic event. Results: A total of 175 children aged 6–14 years and 174 parents participated in the study. Stress was diagnosed in 33.7% of children after one week, and in 9.9% after one month. Parental responses suggesting stress presence in their children were 19.0% and 3.9%, respectively. These outcomes showed that mild head injuries are not so innocent. They are often underestimated by their parents and may generate a psychological burden to the children during the early post-traumatic period. Conclusions: Mild head injuries may affect the emotional welfare of children. Healthcare providers should understand the importance of the psychological effect of this overlooked type of injury. They should be trained in the psychological effect of trauma and be aware of this probability, promptly notify the parents accordingly, and provide psychological assistance beyond medical treatment. Follow-up and support are needed to avoid the possibility of future post-traumatic stress disorder. More extensive research is needed as the outcomes of this study regarded a limited population in numbers, age, and survey period. Furthermore, many children with mild head injuries do not ever visit the emergency department and stay at home unrecorded. Community-based research on the topic should therefore be considered.

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Section: Introductionmentioning

confidence: 99%

Post-Traumatic Stress as a Psychological Effect of Mild Head Injuries in Children

et al. 2023

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Low-Value Clinical Practices in Pediatric Trauma Care

Deshommes,

Freire,

Yanchar

et al. 2024

JAMA Netw Open

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ImportanceReducing low-value care has the potential to improve patient experiences and outcomes and decrease the unnecessary use of health care resources. Research suggests that low-value practices (ie, the potential for harm exceeds the potential for benefit) in adult trauma care are frequent and subject to interhospital variation; evidence on low-value practices in pediatric trauma care is lacking.ObjectiveTo estimate the incidence of low-value practices in pediatric trauma care and evaluate interhospital practice variation.Design, Setting, and ParticipantsA retrospective multicenter cohort study in a Canadian provincial trauma system was conducted. Children younger than 16 years admitted to any of the 59 provincial trauma centers from April 1, 2016, to March 31, 2022, were included.Main Outcomes and MeasuresLow-value practices were identified from systematic reviews of clinical practice guidelines on pediatric trauma. The frequencies of low-value practices were evaluated by estimating incidence proportions and cases per 1000 admissions (low if ≤10% and ≤10 cases, moderate if &gt;10% or &gt;10 cases, and high if &gt;10% and &gt;10 cases) were identified. Interhospital variation with intraclass correlation coefficients (ICCs) were assessed (low if &lt;5%, moderate if 5%-20%, and high if &gt;20%).ResultsA total of 10 711 children were included (mean [SD] age, 7.4 [4.9] years; 6645 [62%] boys). Nineteen low-value practices on imaging, fluid resuscitation, hospital/intensive care unit admission, specialist consultation, deep vein thrombosis prophylaxis, and surgical management of solid organ injuries were identified. Of these, 14 (74%) could be evaluated using trauma registry data. Five practices had moderate to high frequencies and interhospital variation: head computed tomography in low-risk children (7.1%; 33 per 1000 admissions; ICC, 8.6%), pretransfer computed tomography in children with a clear indication for transfer (67.6%; 4 per 1000 admissions; ICC, 5.7%), neurosurgical consultation in children without clinically important intracranial lesions (11.6%; 13 per 1000 admissions; ICC, 15.8%), hospital admission in isolated mild traumatic brain injury (38.8%; 98 per 1000 admissions; ICC, 12.4%), and hospital admission in isolated minor blunt abdominal trauma (10%; 5 per 1000 admissions; ICC, 31%).Conclusions and RelevanceIn this cohort study, low-value practices appeared to be frequent and subject to interhospital variation. These practices may represent priority targets for deimplementation interventions, particularly as they can be measured using routinely collected data.

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Clinical Practice Guideline Recommendations in Pediatric Mild Traumatic Brain Injury: A Systematic Review

Moore,

Ben Abdeljelil,

Tardif

et al. 2024

Annals of Emergency Medicine

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Pediatric Mild Traumatic Brain Injury: Who Can Be Managed at a Non-pediatric Trauma Center Hospital? A Systematic Review of the Literature

Cited by 7 publications

References 26 publications

Post-Traumatic Stress as a Psychological Effect of Mild Head Injuries in Children

Post-Traumatic Stress as a Psychological Effect of Mild Head Injuries in Children

Low-Value Clinical Practices in Pediatric Trauma Care

Clinical Practice Guideline Recommendations in Pediatric Mild Traumatic Brain Injury: A Systematic Review

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