Prediction of intracranial injury in children aged five years and older with loss of consciousness after minor head injury due to nontrivial mechanisms

Haydel, Micelle J.; Shembekar, Amit

doi:10.1067/s0196-0644(03)00512-2

Cited by 103 publications

(85 citation statements)

References 45 publications

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“…Previous studies have addressed this same problem, both in adults 3,4,8,17,19,20,[23][24][25] and in children 4,7-11,13-15,18-25 but have not been able to develop an instrument applicable to all age groups, with CIs for their performance characteristics far too wide to allow any of them to be clinically acceptable at this time.…”

Section: Discussionmentioning

confidence: 96%

“…Although these reports provide some preliminary evidence, limitations in study design, including retrospective chart review, small sample size, and restricted age or selection criteria, limit the strength of any of these instruments. [7][8][9][10][11][13][14][15][18][19][20][21][22][23][24][25] The National Emergency X-Radiography Utilization Study II (NEXUS II) is an ongoing, prospective, multicenter study of blunt head trauma victims that was designed to derive and subsequently validate a decision aid to identify a group of patients, from among those with head trauma, who are at very low risk for significant ICI, thus enabling a reduction in unwarranted cranial CT imaging. 26,27 The derivation set of NEXUS II identified a decision aid, based on both adult and pediatric patients, that was highly sensitive (98.3%; 95% confidence interval [CI]: 97.2-99.0) for ICI in this cohort, excluded a significant lesion with high negative predictive value (NPV: 99.1%; 95% CI: 98.5-99.5), and, if prospectively validated, should be able to identify safely a small subset of patients who can be discharged without imaging (13.7%; 95% CI: 13.1-14.3).…”

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confidence: 99%

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Performance of a Decision Rule to Predict Need for Computed Tomography Among Children With Blunt Head Trauma

Oman

Cooper

Holmes³

et al. 2006

Pediatrics

109

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OBJECTIVE. To assess the ability of the NEXUS II head trauma decision instrument to identify patients with clinically important intracranial injury (ICI) from among children with blunt head trauma.METHODS. An analysis was conducted of the pediatric cohort involved in the derivation set of National Emergency X-Radiography Utilization Study II (NEXUS II), a prospective, observational, multicenter study of all patients who had blunt head trauma and underwent cranial computed tomography (CT) imaging at 1 of 21 emergency departments. We determined the test performance characteristics of the 8-variable NEXUS II decision instrument, derived from the entire NEXUS II cohort, in the pediatric cohort (0 -18 years of age), as well as in the very young children (Ͻ3 years). Clinically important ICI was defined as ICI that required neurosurgical intervention (craniotomy, intracranial pressure monitoring, or mechanical ventilation) or was likely to be associated with significant long-term neurologic impairment.RESULTS. NEXUS II enrolled 1666 children, 138 (8.3%) of whom had clinically important ICI. The decision instrument correctly identified 136 of the 138 cases and classified 230 as low risk. A total of 309 children were younger than 3 years, among whom 25 had ICI. The decision instrument identified all 25 cases of clinically important ICI in this subgroup.CONCLUSIONS. The decision instrument derived in the large NEXUS II cohort performed with similarly high sensitivity among the subgroup of children who were included in this study. Clinically important ICI were rare in children who did not exhibit at least 1 of the NEXUS II risk criteria. a common cause of emergency-department (ED) presentation, accounting for ϳ1 million visits annually. 1 Although the majority of patients with head trauma have a minor injury that requires no specific therapy, a small number prove to have clinically significant intracranial injury (ICI). Because of the risk of unrecognized ICI, clinicians liberally order cranial computed tomography (CT) in blunt trauma, generating annual charges of nearly $750 million while revealing significant ICI in Ͻ60 000 patients. [2][3][4] The overuse of CT may be even more pronounced in children, who comprise almost 40% of these patients, 5 because of the greater difficulty in assessing neurologic function in at least some of them.A number of investigators have attempted to identify clinical criteria that accurately predict which patients are at risk for ICI and thus limit CT imaging to such patients. Although these reports provide some preliminary evidence, limitations in study design, including retrospective chart review, small sample size, and restricted age or selection criteria, limit the strength of any of these instruments. [7][8][9][10][11][13][14][15][18][19][20][21][22][23][24][25] The National Emergency X-Radiography Utilization Study II (NEXUS II) is an ongoing, prospective, multicenter study of blunt head trauma victims that was designed to derive and subsequently validate a decision aid to ide...

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Section: Discussionmentioning

confidence: 96%

mentioning

confidence: 99%

Performance of a Decision Rule to Predict Need for Computed Tomography Among Children With Blunt Head Trauma

Oman

Cooper

Holmes³

et al. 2006

Pediatrics

109

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“…Haydel et al, (2003) reported in their study with children 5-17 years of age with minor head trauma, 8% cases had cranial fracture or intracranial pathology on CT and 7.1% of these required operations. Borzcuk et al, (1995) reported 1211(83.6%) patients had Glaskow Coma Scale 15 in 1448 cases.…”

Section: Discussionmentioning

confidence: 99%

How necessary is computed tomography in pediatric minor head trauma?

Mete¹,

Duransoy²,

Karabıyık³

et al. 2011

jecm

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Computerized tomography (CT) is very often used for head injury. Especially in childhood as related to the use of CT is known that a number of drawbacks. At the age of fifteen and under with minor head trauma, it is very difficult to assess whether CT is necessary. The purpose of this study was to assess the necessarity of CT in children who are at 15 years of age and under with minor head trauma. The records of 115 cases who applied with minor head trauma between

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“…14 Prior to the CATCH study, numerous studies have attempted to derive a CDR for pediatric minor head injury. [15][16][17][18][19][20] A recent study by the Pediatric Emergency Care Applied Research Network (PECARN) in the United States derived and validated a CDR for children with minor head injuries. 21 This study was similar to the CATCH study in study design and inclusion criteria, but the PECARN study analyzed children under 2 years of age separately from those aged 2 to 16 years.…”

Section: Commentarymentioning

confidence: 99%

Review of the CATCH study: a clinical decision rule for the use of computed tomography in children with minor head injury

Gerdung

Dowling

Lang

2012

CJEM

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Prediction of intracranial injury in children aged five years and older with loss of consciousness after minor head injury due to nontrivial mechanisms

Cited by 103 publications

References 45 publications

Performance of a Decision Rule to Predict Need for Computed Tomography Among Children With Blunt Head Trauma

Performance of a Decision Rule to Predict Need for Computed Tomography Among Children With Blunt Head Trauma

How necessary is computed tomography in pediatric minor head trauma?

Review of the CATCH study: a clinical decision rule for the use of computed tomography in children with minor head injury

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