Pitfalls in the interpretation of pediatric head CTs: what the emergency radiologist needs to know

Hodges, Hannah; Epstein, Katherine; Retrouvey, Michele; Wang, Sherry S.; Richards, Allyson; Lima, D. B. C.; Revels, Jonathan

doi:10.1007/s10140-022-02042-4

Cited by 3 publications

(2 citation statements)

References 64 publications

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“…The initial literature review screened more than 200 articles, from which relevant articles were reviewed in detail. Twenty candidate criterion statements were developed based on published general/procedural criteria, 4,[9][10][11][12][13][14][15][16] as well as specific criteria for emergent vascular access, [17][18][19][20] crystalloid volume/ timing, 21 surgical intervention, 22,23 anesthesia/sedation, [24][25][26][27][28] intensive care, 29 transfusion, 30,31 blunt abdominal trauma/solid organ injury, [32][33][34] diagnostic/interventional radiology, [35][36][37][38] child abuse, 39,40 and rehabilitation. [41][42][43][44][45] Fifteen panelists participated in the initial feedback session.…”

Section: Resultsmentioning

confidence: 99%

Defining pediatric trauma center resource utilization: Multidisciplinary consensus-based criteria from the Pediatric Trauma Society

Snyder,

Kristiansen,

Jensen

et al. 2023

J Trauma Acute Care Surg

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Background Pediatric trauma triage and transfer decisions should incorporate the likelihood that an injured child will require pediatric trauma center (PTC) resources. Resource utilization may be a better basis than mortality risk when evaluating pediatric injury severity. However, there is currently no consensus definition of PTC resource utilization that encompasses the full scope of PTC services. Methods Consensus criteria were developed in collaboration with the Pediatric Trauma Society (PTS) Research Committee using a modified Delphi approach. An expert panel was recruited representing the following pediatric disciplines: prehospital care, emergency medicine, nursing, general surgery, neurosurgery, orthopedics, anesthesia, radiology, critical care, child abuse, and rehabilitation medicine. Resource utilization criteria were drafted from a comprehensive literature review, seeking to complete the following sentence: “Pediatric patients with traumatic injuries have used PTC resources if they..." Criteria were then refined and underwent three rounds of voting to achieve consensus. Consensus was defined as agreement of 75% or more panelists. Between the second and third voting rounds, broad feedback from attendees of the PTS annual meeting was obtained. Results The Delphi panel consisted of 18 members from 15 institutions. Twenty initial draft criteria were developed based on literature review. These criteria dealt with airway interventions, vascular access, initial stabilization procedures, fluid resuscitation, blood product transfusion, abdominal trauma/solid organ injury management, intensive care monitoring, anesthesia/sedation, advanced imaging, radiologic interpretation, child abuse evaluation, and rehabilitative services. After refinement and panel voting, 14 criteria achieved the >75% consensus threshold. The final consensus criteria were reviewed and endorsed by the PTS Guidelines Committee. Conclusions This study defines multidisciplinary consensus-based criteria for PTC resource utilization. These criteria are an important step toward developing a gold standard, resource-based, pediatric injury severity metric. Such metrics can help optimize system-level pediatric trauma triage based on likelihood of requiring PTC resources. Level of Evidence/Study Type Level II, diagnostic test/criteria

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Section: Resultsmentioning

confidence: 99%

Defining pediatric trauma center resource utilization: Multidisciplinary consensus-based criteria from the Pediatric Trauma Society

Snyder,

Kristiansen,

Jensen

et al. 2023

J Trauma Acute Care Surg

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“… 31 Additionally, radiologists who initially interpreted HCT were not all pediatric radiologists; hence, we could not exclude whether some age-related specificities were misinterpreted. 26 , 32 , 33 , 34 Although all had at least 2.5 years of experience in emergency radiology and could refer to a senior radiologist for complementary advice during the on-call period.…”

Section: Discussionmentioning

confidence: 99%

Risk Factors Associated with Traumatic Brain Injury and Implementation of Guidelines for Requesting Computed Tomography After Head Trauma Among Children in France

Roche¹,

Crombé

Benhamed

et al. 2023

JAMA Netw Open

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ImportancePediatric traumatic brain injuries (TBIs) are a leading cause of death and disability. The Pediatric Emergency Care Applied Research Network (PECARN) guidelines provide a framework for requesting head computed tomography (HCT) after pediatric head trauma (PHT); however, quantitative data are lacking regarding both TBIs found on HCT and justification of the HCT request according to the PECARN guidelines.ObjectivesTo evaluate the types, frequencies, and risk factors for TBIs on HCT in children referred to emergency departments (EDs) who underwent HCT for PHT and to evaluate quality of HCT request.Design, Setting, and ParticipantsThis multicenter, retrospective cohort study included patients younger than 18 years who underwent HCT for PHT who were referred to 91 EDs during on-call hours between January 1, 2020, to May 31, 2022. Data were analyzed between July and August 2022.ExposureAll radiological reports with pathologic findings were reviewed by 4 senior radiologists. Six hundred HCT requests filled by emergency physicians were randomly sampled to review the examination justification according to the PECARN guidelines.Main Outcomes and MeasuresAssociations between TBIs, age, sex, and Glasgow Coma Scale (GCS) were investigated using univariable χ2 and Cochrane-Armitage tests. Multivariable stepwise binary logistic regressions were used to estimate the odds ratio (ORs) for intracranial hemorrhages (ICH), any type of fracture, facial bone fracture, and skull vault fracture.ResultsOverall, 5146 children with HCT for PHT were included (median [IQR] age, 11.2 [4.7-15.7] years; 3245 of 5146 [63.1%] boys). ICHs were diagnosed in 306 of 5146 patients (5.9%) and fractures in 674 of 5146 patients (13.1%). The following variables were associated with ICH in multivariable analysis: GCS score of 8 or less (OR, 5.83; 95% CI, 1.97-14.60; P &lt; .001), extracranial hematoma (OR, 2.54; 95% CI, 1.59-4.02; P &lt; .001), skull base fracture (OR, 9.32; 95% CI, 5.03-16.97; P &lt; .001), upper cervical fracture (OR, 19.21; 95% CI, 1.79-143.59; P = .006), and skull vault fracture (OR, 35.64; 95% CI, 24.04-53.83; P &lt; .001). When neither extracranial hematoma nor fracture was found on HCT, the OR for presenting ICH was 0.034 (95% CI, 0.026-0.045; P &lt; .001). Skull vault fractures were more frequently encountered in children younger than 2 years (multivariable OR, 6.31; 95% CI, 4.16-9.66; P &lt; .001; reference: children ≥12 years), whereas facial bone fractures were more frequently encountered in boys older than 12 years (multivariable OR, 26.60; 95% CI, 9.72-109.96; P &lt; .001; reference: children younger than 2 years). The justification for performing HCT did not follow the PECARN guidelines for 396 of 589 evaluable children (67.2%) for requests filled by emergency physicians.Conclusion and RelevanceIn this cohort study of 5146 children who underwent HCT for PHT, knowing the odds of clinical and radiological features for ICHs and fractures could help emergency physicians and radiologists improve their image analysis and avoid missing significant injuries. The PECARN rules were not implemented in nearly two-thirds of patients.

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Pediatric Trauma Computed Tomography: A Comprehensive Guide

Joshi,

Schenker,

Nikam

et al. 2023

Trauma Computed Tomography

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Pitfalls in the interpretation of pediatric head CTs: what the emergency radiologist needs to know

Cited by 3 publications

References 64 publications

Defining pediatric trauma center resource utilization: Multidisciplinary consensus-based criteria from the Pediatric Trauma Society

Defining pediatric trauma center resource utilization: Multidisciplinary consensus-based criteria from the Pediatric Trauma Society

Risk Factors Associated with Traumatic Brain Injury and Implementation of Guidelines for Requesting Computed Tomography After Head Trauma Among Children in France

Pediatric Trauma Computed Tomography: A Comprehensive Guide

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