Developing a clinical decision instrument to rule out intracranial injuries in patients with minor head trauma: Methodology of the NEXUS II investigation

2002 ◽  
Vol 40 (5) ◽  
pp. 505-515 ◽  
Author(s):  
William R. Mower ◽  
Jerome R. Hoffman ◽  
Mel Herbert ◽  
Allan B. Wolfson ◽  
Charles V. Pollack ◽  
...  
Keyword(s):  
Head Trauma ◽  
Clinical Decision ◽  
Minor Head Trauma ◽  
Rule Out

scholarly journals Variation in the use of skull radiographs by emergency physicians in young children with minor head trauma

CJEM ◽  
2014 ◽  
Vol 16 (04) ◽  
pp. 281-287 ◽  
Author(s):  
Benoit Carrière ◽  
Karine Clément ◽  
Jocelyn Gravel
Keyword(s):  
Young Children ◽  
Decision Rule ◽  
Head Trauma ◽  
Clinical Decision ◽  
Pediatric Emergency ◽  
Emergency Department Visits ◽  
Minor Head Trauma ◽  
Emergency Physicians ◽  
Clinical Decision Rule ◽  
Skull Radiographs

ABSTRACTBackground:Minor head trauma in young children is a major cause of emergency department visits. Conflicting guidelines exist regarding radiologic evaluation in such cases.Objective:To determine the practice pattern among Canadian emergency physicians for ordering skull radiographs in young children suffering from minor head trauma. Physicians were also surveyed on their willingness to use a clinical decision rule in such cases.Design/Methods:A self-administered email questionnaire was sent to all members of the Pediatric Emergency Research Canada (PERC) group. It consisted of clinical vignettes followed by multiple-option answers on the management plan. The study was conducted using the principles of the Dillman Tailored Design method and included multiple emailings to maximize the response rate. The research protocol received Institutional Review Board approval.Results:A total of 158 of 295 (54%) PERC members responded. Most participants were trained in pediatric emergency medicine and assessed more than 500 children per year. Imaging management for the vignettes was highly variable: 6 of the 11 case scenarios had a proportion of radiograph ordering between 20 and 80%. Ninety-five percent of respondents stated that they would apply a validated clinical decision rule for the detection of skull fracture in young children with minor head trauma. The minimum sensitivity deemed acceptable for such a rule was 98%.Conclusion:Canadian emergency physicians have a wide variation in skull radiography ordering in young children with minor head trauma. This variation, along with the need expressed by physicians, suggests that further research to develop a clinical decision rule is warranted.

scholarly journals External validation and comparison of the Pediatric Emergency Care Applied Research Network and Canadian Assessment of Tomography for Childhood Head Injury 2 clinical decision rules in children with minor blunt head trauma

2021 ◽  
Vol 8 (3) ◽  
pp. 182-191
Author(s):  
Bo Sung Kwon ◽  
Hyung Jun Song ◽  
Jun Hee Lee
Keyword(s):  
Head Injury ◽  
Head Trauma ◽  
Applied Research ◽  
Decision Rules ◽  
Clinical Decision ◽  
Pediatric Emergency ◽  
Research Network ◽  
Minor Head Trauma ◽  
Emergency Rooms ◽  
Pediatric Emergency Care

Objective Among the pediatric population with minor head trauma, it is difficult to determine an indication for the usage of brain computerized tomography (CT). Our study aims to compare the efficiency of the most commonly used clinical decision rules: the Pediatric Emergency Care Applied Research Network (PECARN) and Canadian Assessment of Tomography for Childhood Head Injury 2 (CATCH2).Methods This retrospective study investigated whether the PECARN and CATCH2 rules were applicable to Korean children with minor head trauma for reducing the use of brain CT imaging, while detecting intracranial pathology.Results Overall, 251 patients (0–5 years old) admitted to emergency rooms within 24 hours of injury were included between August 2015 to August 2018. The performance results are as follows: the PECARN and CATCH2 rules had a sensitivity of 80.00% (51.91%–95.67%) and 100% (78.20%–100.00%) with a specificity of 28.39% (22.73%–34.60%) and 15.25% (10.92%–20.49%), respectively; the negative predictive values were 98.58% and 100%, respectively. Overall, the CATCH2 rule was more successful than the PECARN rule in detecting intracranial pathology; however, there was no significant difference between them. Furthermore, the PECARN and CATCH2 rules lowered the rate of head CT imaging in our study group.Conclusion Both the rules significantly lowered the rate of indicated brain CT. However, since the CATCH2 rule had higher sensitivity and negative predictive value than the PECARN rule, it is more appropriate to be used in emergency rooms for detecting intracranial pathology in children with minor head trauma.

scholarly journals Characteristics of minor head trauma in toddlers

2021 ◽  
Vol 38 (4) ◽  
pp. 516-520
Author(s):  
Korkut BOZAN ◽  
Abdullah ALGIN ◽  
Serdar ÖZDEMİR ◽  
Mehmet Özgür ERDOĞAN ◽  
Nazmiye KOYUNCU ◽  
...  
Keyword(s):  
Diagnostic Imaging ◽  
Head Trauma ◽  
Preventive Measures ◽  
Signs And Symptoms ◽  
Cerebral Injury ◽  
Minor Head Trauma ◽  
Decision Making Processes ◽  
One Year ◽  
A Minor ◽  
Rule Out

The objective of present study is to evaluate mechanisms and causes of head trauma, factors influencing management of pediatric minor head trauma, to highlight decision making processes in diagnostic imaging as well as searching for preventive measures for head trauma. Children younger than two years of age who were admitted to emergency department in one-year study period due to minor head trauma were included to the study. To be inside or outside of house did not significantly change the incidence of falls for children younger than two years of age (p=0.096). Incidence of falls was significantly increased at living rooms (p=0.01) and bathrooms (p=0.036). Incidence of scalp hematomas was significantly higher in symptomatic patients (p=0.006). Asymptomatic admission after a minor injury was not a significant factor on decision of diagnostic imaging. A patient’s asymptomatic presentation should not be used as a criterion to rule out cerebral injuries. A lack of obvious signs and symptoms during evaluation does not exclude TBI. Existing serious symptoms should lead to a quick evaluation of patient to rule out a possible surgical emergency. Scalp hematomas are significantly associated with cerebral injury and are a predictor of brain injury. Clinicians should have a lower threshold for imaging in children<2 years of age.

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