The risk of intra-cranial haemorrhage in those presenting late to the ED following a head injury: a systematic review

Marincowitz, Carl; Smith, C. F. C.; Townend, William

doi:10.1186/s13643-015-0154-8

Cited by 8 publications

(7 citation statements)

References 25 publications

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“…Delayed hemorrhage may result from slow venous bleeding, blood dyscrasias, and coagulation disorders. 1 In adults, the available low-quality studies suggest delayed presentations have lower rates of intracranial injury [8][9][10][11][12] and yet account for 15% of cranial CTs undertaken. In addition, there is little evidence on how existing clinical decision rules can be applied to this cohort of patients.…”

Section: How This Is Relevant To Clinical Practicementioning

confidence: 99%

Delayed Presentations to Emergency Departments of Children With Head Injury: A PREDICT Study

Borland

Dalziel

Phillips

et al. 2019

Annals of Emergency Medicine

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Existing clinical decision rules guide management for head-injured children presenting 24 hours or sooner after injury, even though some may present greater than 24 hours afterward. We seek to determine the prevalence of traumatic brain injuries for patients presenting to emergency departments greater than 24 hours after injury and identify symptoms and signs to guide management.Methods: This was a planned secondary analysis of the Australasian Paediatric Head Injury Rule Study, concentrating on first presentations greater than 24 hours after injury, with Glasgow Coma Scale scores 14 and 15. We sought associations with predictors of traumatic brain injury on computed tomography (CT) and clinically important traumatic brain injury.Results: Of 19,765 eligible children, 981 (5.0%) presented greater than 24 hours after injury, and 465 injuries (48.5%) resulted from falls less than 1 m and 37 (3.8%) involved traffic incidents. Features associated significantly with presenting greater than 24 hours after injury in comparison with presenting within 24 hours were nonfrontal scalp hematoma (20.8% versus 18.1%), headache (31.6% versus 19.9%), vomiting (30.0% versus 16.3%), and assault with nonaccidental injury concerns (1.4% versus 0.4%). Traumatic brain injury on CT occurred in 37 patients (3.8%), including suspicion of depressed skull fracture (8 [0.8%]) and intracranial hemorrhage (31 [3.8%]). Clinically important traumatic brain injury occurred in 8 patients (0.8%), with 2 (0.2%) requiring neurosurgery, with no deaths. Suspicion of depressed skull fracture was associated with traumatic brain injury on CT consistently, with the only other significant factor being nonfrontal scalp hematoma (odds ratio 19.0; 95% confidence interval 8.2 to 43.9). Clinically important traumatic brain injury was also associated with nonfrontal scalp hematoma (odds ratio 11.7; 95% confidence interval 2.4 to 58.6) and suspicion of depressed fracture (odds ratio 19.7; 95% confidence interval 2.1 to 182.1). Conclusion:Delayed presentation after head injury, although infrequent, is significantly associated with traumatic brain injury. Evaluation of delayed presentations must consider identified factors associated with this increased risk.

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Section: How This Is Relevant To Clinical Practicementioning

confidence: 99%

Delayed Presentations to Emergency Departments of Children With Head Injury: A PREDICT Study

Borland

Dalziel

Phillips

et al. 2019

Annals of Emergency Medicine

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“…Scarcity of research related to this group is accepted in the literature. 12,13 Our objectives in this study are 1. to compare the use and sensitivity of PECARN and CATCH clinical decision rules in children with MHT presenting 24 hours after injury and who underwent CBT imaging; 2. to determine the incidence of traumatic computed tomography (CT) findings in children with MHT presenting 24 hours after injury and who were screened for CBT; and 3. to compare the incidence of traumatic CT findings in children with MHT presenting within or after the first 24 hours of the injury and who underwent CBT imaging.…”

mentioning

confidence: 99%

“…However, it is unclear whether this evidence suggests that the incidence of TBI is lower in patients presenting after 24 hours. Scarcity of research related to this group is accepted in the literature 12,13 …”

mentioning

confidence: 99%

The Use of PECARN and CATCH Rules in Children With Minor Head Trauma Presenting to Emergency Department 24 Hours After Injury

2020

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Objective: Major studies (PECARN [Pediatric Emergency Care AppliedResearch Network], CATCH [Canadian Assessment of Childhood Head Injury]) that regulate the use of computed tomography (CT) algorithms in children with minor head trauma (MHT) have been conducted among children presenting in 24 hours after injury. In this study, we aimed to compare use and results of PECARN and CATCH rules in children presenting in and after 24 hours following injury.Methods: Records of children who were admitted to emergency department and underwent CT imaging because of MHT during a 5-year period were retrospectively reviewed. Efficacy of PECARN and CATCH rules was investigated for predicting traumatic CT findings in patients presenting in and after 24 hours. Logistic regression was performed to evaluate whether presenting after 24 hours affected the ability of guidelines in predicting traumatic CT findings.Results: This study included 2490 patients who met the criteria. Of these patients, 6.7% (168/2490) presented after 24 hours following injury. Traumatic CT findings were found in 6.7% (168/2490) of patients. This rate was 6.9% (161/2322) in those presenting in 24 hours and 4.2% (7/168) in those presenting after 24 hours, and there was no significant difference in the incidence of traumatic CT findings between the 2 groups (P = 0.17). Among children presenting in 24 hours, the sensitivity of PECARN was 96.3% (95% confidence interval [CI], 91.7%-98.5%), whereas the sensitivity of CATCH was 91.9% (95% CI, 86.3%-95.4%) in detecting traumatic intracranial injury. The sensitivity of both PECARN and CATCH was 85.7% (95% CI, 42.0%-99.2%) among children presenting after 24 hours. Presence of CT scan indication according to PECARN statistically predicted intracranial damage, and this was not affected by the admission time.Conclusions: Patients with MHT presenting after 24 hours following injury constitute a clinically important population. Regardless of the admission time, current guidelines predict traumatic CT abnormalities.

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“…One adult study showed lower rates of intracranial injuries in patients who presented to emergency departments more than 24 h after a head injury than those who presented earlier 17 . It has also been suggested that the scores that are currently available effectively predict the occurrence of significant injuries 18 .…”

Section: Discussionmentioning

confidence: 99%

Multicentre study found no increased risk of clinically important brain injuries when children presented more than 24 h after a minor head trauma

Pava¹,

Milani

Zuccotti

et al. 2022

Acta Paediatrica

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Aim: Validated clinical decision rules on neuroimaging are not available for children who are evaluated more than 24 h after a minor head trauma. We compared clinically important traumatic brain injuries in children who presented with a minor head trauma within or after 24 h. Methods:This was a retrospective analysis of patients aged 0-17 years, who were evaluated for minor head traumas by five paediatric emergency departments in Northern Italy between January 2019 and June 2020. Children with clinically important traumatic brain injuries were divided into those who had presented within and after 24 h. Results:The study comprised 5981 children (59.9% boys), with a median age of 2 years, including 243 (4.1%) who had presented more than 24 h after their minor head trauma. Neuroimaging was performed on 448 (7.5%) patients and the time of presentation had no impact on the rates of clinically important traumatic brain injuries.Multiple logistic regression did not show any association between clinically important traumatic brain injuries and late presentation. Conclusion:Delayed presentation to a paediatric emergency department after a minor head trauma did not alter the risk of clinically important traumatic brain injuries and the same neuroimaging rules could apply.

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The risk of intra-cranial haemorrhage in those presenting late to the ED following a head injury: a systematic review

Cited by 8 publications

References 25 publications

Delayed Presentations to Emergency Departments of Children With Head Injury: A PREDICT Study

Delayed Presentations to Emergency Departments of Children With Head Injury: A PREDICT Study

The Use of PECARN and CATCH Rules in Children With Minor Head Trauma Presenting to Emergency Department 24 Hours After Injury

Multicentre study found no increased risk of clinically important brain injuries when children presented more than 24 h after a minor head trauma

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