Predictors of intracranial injuries in children after blunt head trauma

Dalt, Liviana Da; Marchi, Alberto; Laudizi, L; Crichiutti, Giovanni; Messi, G; Pavanello, Lucia; Valent, Francesca; Barbone, Fabio

doi:10.1007/s00431-005-0019-6

Cited by 78 publications

(82 citation statements)

References 33 publications

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“…6,[14][15][16][17] In a systematic review, "any headache" had a pooled negative likelihood ratio (LR) of 0.91 (95% CI: 0.78-1.01) and positive LR of 1.26 (95% CI: 0.97-1.61) for intracranial injury on CT. 6 "Severe or persistent headache" had a similar pooled negative LR of 0.92 (95% CI: 0.87-0.99) but did have a positive LR of 4.35 (1.07-12.35) for intracranial injury.…”

Section: Discussionmentioning

confidence: 99%

Headache in Traumatic Brain Injuries From Blunt Head Trauma

Dayan

Holmes²,

Hoyle

et al. 2015

Pediatrics

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OBJECTIVE: To determine the risk of traumatic brain injuries (TBIs) in children with headaches after minor blunt head trauma, particularly when the headaches occur without other findings suggestive of TBIs (ie, isolated headaches).METHODS: This was a secondary analysis of a prospective observational study of children 2 to 18 years with minor blunt head trauma (ie, Glasgow Coma Scale scores of 14-15). Clinicians assessed the history and characteristics of headaches at the time of initial evaluation, and documented findings onto case report forms. Our outcome measures were (1) clinically important TBI (ciTBI) and (2) TBI visible on computed tomography (CT). RESULTS:Of 27 495 eligible patients, 12 675 (46.1%) had headaches. Of the 12 567 patients who had complete data, 2462 (19.6%) had isolated headaches. ciTBIs occurred in 0 of 2462 patients (0%; 95% confidence interval [CI]: 0%-0.1%) in the isolated headache group versus 162 of 10 105 patients (1.6%; 95% CI: 1.4%-1.9%) in the nonisolated headache group (risk difference, 1.6%; 95% CI: 1.3%-1.9%). TBIs on CT occurred in 3 of 456 patients (0.7%; 95% CI: 0.1%-1.9%) in the isolated headache group versus 271 of 6089 patients (4.5%; 95% CI: 3.9%-5.0%) in the nonisolated headache group (risk difference, 3.8%; 95% CI: 2.3%-4.5%). We found no significant independent associations between the risk of ciTBI or TBI on CT with either headache severity or location.CONCLUSIONS: ciTBIs are rare and TBIs on CT are very uncommon in children with minor blunt head trauma when headaches are their only sign or symptom. WHAT'S KNOWN ON THIS SUBJECT:Although headache is a common symptom after minor blunt head trauma in children, controversy exists whether the presence of headache increases the risk of traumatic brain injury. WHAT THIS STUDY ADDS:Clinically important traumatic brain injuries are rare, and traumatic brain injuries on computed tomography are very uncommon in children with minor blunt head trauma when headaches are their only sign or symptom. Dr Dayan conceived of and designed the study, including the data collection instruments, supervised the conduct of the study and data collection at his center, and drafted the initial manuscript; Dr Kuppermann conceived of and designed the study, including the data collection instruments, supervised the conduct of the study and data collection at his center, obtained research funding, and critically reviewed the manuscript; Drs Holmes, Atabaki, Hoyle Jr, Tunik, and Lichenstein supervised the conduct of the study and data collection at their sites and critically reviewed the manuscript; Ms Miskin managed the data, including quality control, conducted all analyses, and reviewed and revised the manuscript; and all authors approved the final manuscript as submitted. Computed tomography (CT) scans must be used judiciously in children with minor head trauma, balancing the need to identify important injuries with the risks of radiation-induced malignancy. 4,5 Children with minor blunt head trauma frequently present to the ED with histo...

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Section: Discussionmentioning

confidence: 99%

Headache in Traumatic Brain Injuries From Blunt Head Trauma

Dayan

Holmes²,

Hoyle

et al. 2015

Pediatrics

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“…Da Dalt ve ark (15), non-frontal skalp hematomuna <2 yaş grubunda daha büyük yaş gruplarına göre daha sık rastlandığını saptamışlardır. Özsaraç ve ark.…”

Section: Discussionunclassified

“…Minör Kafa Travmalı İnfantlar olarak, bu grupta kranial BT çekimi için sedasyon gerekmekte, bu da hipoksi, apne, bilinç düzeyinde değişiklik, aspirasyon riski ve belkide endotrakeal entübasyon gibi pek çok ek riski beraberinde getirmektedir (12)(13)(14)(15)(16). Özellikle 1 yaş altında BT kaynaklı radyasyona maruziyet maligniteler ve bunlara bağlı mortalite riskinde artışa neden olmaktadır (17)(18)(19).…”

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Is Cranial Computerized Tomography Really Necessary for Infants With Minor Head Trauma?

Köksal¹,

Ozeren²,

Yenice³

et al. 2011

JAEM

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“…3 CT-diagnosed mild head injuries occur in a very small percentage of all patients with suspected concussion. 4,19 There are no evidence-based recommendations regarding use of MRI compared with CT in acute setting. 4 Seven predictors of abnormal CT-scan findings in patients with concussion have been identified: headache, vomiting, age >60 years, intoxication, deficit in short-term memory (persistent anterograde amnesia), physical evidence of any trauma above the clavicle, and seizure.…”

Section: Non-english Abstracts Translated For Reviewmentioning

confidence: 99%

Differentiating Concussion From Intracranial Pathology in Athletes

Cripps¹,

Livingston²

2017

Journal of Sport Rehabilitation

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Clinical Scenario: A cerebral concussion is a traumatically induced transient disturbance of brain function characterized by a complex pathophysiologic process and is classified as a subset of mild traumatic brain injury. The occurrence of intracranial lesions after sport-related head injury is relatively uncommon, but the possibility of serious intracranial injury (ICI) should be included in the differential diagnosis. ICIs are potentially life threatening and necessitate urgent medical management; therefore, prompt recognition and evaluation are critical to proper medical management. One of the primary objectives of the initial evaluation is to determine if the concussed athlete has an acute traumatic ICI. Athletic trainers must be able promptly recognize clinical signs and symptoms that will enable them to accurately differentiate between a concussion (ie, a closed head injury not associated with significant ICI) and an ICI. The identification of predictors of intracranial lesions is, however, relatively broad. Clinical ScenarioA cerebral concussion is a traumatically induced transient disturbance of brain function characterized by a complex pathophysiologic process and is classified as a subset of mild traumatic brain injury. 1 The occurrence of intracranial lesions after sport-related head injury is relatively uncommon, 2 but the possibility of serious intracranial injury (ICI) should be included in the differential diagnosis. ICIs are potentially life threatening and necessitate urgent medical management; therefore, prompt recognition and evaluation are critical to proper medical management. One of the primary objective of the initial evaluation is to determine if the concussed athlete has an acute traumatic ICI. 3 Athletic trainers must be able promptly recognize clinical signs and symptoms that will enable them to accurately differentiate between a concussion (ie, a closed head injury not associated with significant ICI) and an ICI. The identification of predictors of intracranial lesions is, however, relatively broad. 4 Focused Clinical QuestionWhich clinical examination findings (ie, clinical signs and symptoms) indicate possible intracranial pathology in individuals with acute closed head injuries?

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Predictors of intracranial injuries in children after blunt head trauma

Cited by 78 publications

References 33 publications

Headache in Traumatic Brain Injuries From Blunt Head Trauma

Headache in Traumatic Brain Injuries From Blunt Head Trauma

Is Cranial Computerized Tomography Really Necessary for Infants With Minor Head Trauma?

Differentiating Concussion From Intracranial Pathology in Athletes

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