Emergency Physicians’ Approach to Minor Head Trauma in Pediatric Patients

Managing the anxiety of the parents of pediatric patients with head trauma is challenging. This study aimed to examine the factors that affect anxiety levels of parents whose children were admitted to the emergency department with minor head trauma. In this prospective study, the parents of 663 consecutive pediatric patients were invited to answer a questionnaire. Parents of 600 children participated in the study. The parents who believed they were provided sufficient information and who were satisfied with the service received had significantly more improvement in anxiety-related questions. Cranial X-ray assessment had a significantly positive impact on the anxiety of the parents, whereas cranial computed tomography and neurosurgery consultation did not. In assessing pediatric minor head trauma, cranial computed tomography imaging and neurosurgery consultation should not be expected to relieve the anxiety of the parents. However, adequately informing them and providing satisfaction are the factors that could lead to improvement.

Download Full-text

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

CJEM ◽

10.2310/8000.2013.131081 ◽

2014 ◽

Vol 16 (04) ◽

pp. 281-287 ◽

Cited By ~ 1

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.

Download Full-text

Racial Disparities in Diagnosis of Concussion and Minor Head Trauma and Mechanism of Injury in Pediatric Patients Visiting the Emergency Department

The Journal of Pediatrics ◽

10.1016/j.jpeds.2021.01.057 ◽

2021 ◽

Author(s):

Jessica S. Wallace ◽

Rebekah C. Mannix

Keyword(s):

Emergency Department ◽

Racial Disparities ◽

Head Trauma ◽

Pediatric Patients ◽

Minor Head Trauma ◽

Mechanism Of Injury

Download Full-text

PECARN rule in diagnostic process of pediatric patients with minor head trauma in emergency department

10.21203/rs.3.rs-231804/v1 ◽

2021 ◽

Author(s):

Alessandro Gambacorta ◽

Marianna Moro ◽

Antonietta Curatola ◽

Federica Brancato ◽

Marcello Covino ◽

...

Keyword(s):

Emergency Department ◽

Retrospective Study ◽

Ionizing Radiation ◽

Head Trauma ◽

Pediatric Patients ◽

Age Groups ◽

Diagnostic Process ◽

Risk Category ◽

Age Group ◽

Minor Head Trauma

Abstract Aim: To evaluate the efficacy of the PECARN Rule (PR) in preventing the presence of clinically important traumatic brain (ciTBI).Methods: A retrospective study was performed to our hospital between July 2015 and June 2020. Data of all children <18 years of age admitted to the Emergency Department (ED), within the 24 hours after a head trauma with GCS ≥14, were analysed. PR was retrospectively applied to all patientsResults: 3832 patients were enrolled, 2613 patients ≥2 years and 1219 were younger. In the group of children ≥2 years, 10 presented ciTBI of which 7 underwent neurosurgery and 3 hospitalized. Applying the PR, no patient with ciTBI would have been discharged without a diagnosis. Between children <2 years, only 3 patients presented ciTBI, 2 underwent neurosurgery and 1 hospitalized. According the PR also in this age group no ciTBI would have been discharged without diagnosis. Conclusions: We demonstrate the total effectiveness of the PR in our setting. We found 100% sensitivity in both age groups in identifying patients with ciTBI. Therefore, in patients classified in the low-risk category, it is a duty of the physician not to expose the child to ionizing radiation.

Download Full-text

Validity of serum tau protein levels in pediatric patients with minor head trauma

The American Journal of Emergency Medicine ◽

10.1016/j.ajem.2008.12.025 ◽

2010 ◽

Vol 28 (4) ◽

pp. 399-403 ◽

Cited By ~ 19

Author(s):

Ahmet Guzel ◽

Serap Karasalihoglu ◽

Hakan Aylanç ◽

Osman Temizöz ◽

Tufan Hiçdönmez

Keyword(s):

Head Trauma ◽

Tau Protein ◽

Pediatric Patients ◽

Minor Head Trauma ◽

Protein Levels

Download Full-text

Indications for computed tomography use and frequency of traumatic abnormalities based on real-world data of 2405 pediatric patients with minor head trauma

Surgical Neurology International ◽

10.25259/sni_176_2021 ◽

2021 ◽

Vol 12 ◽

pp. 321

Author(s):

Yuhei Michiwaki ◽

Naoki Maehara ◽

Nice Ren ◽

Yosuke Kawano ◽

Shintaro Nagaoka ◽

...

Keyword(s):

Computed Tomography ◽

High Altitude ◽

Head Trauma ◽

Medical Records ◽

Pediatric Patients ◽

Skull Fracture ◽

Minor Head Trauma ◽

Real World Data ◽

Traumatic Intracranial Hemorrhage ◽

Gcs Score

Background: In pediatric patients with minor head trauma, computed tomography (CT) is often performed beyond the scope of recommendations that are based on existing algorithms. Herein, we evaluated pediatric patients with minor head trauma who underwent CT examinations, quantified its frequency, and determined how often traumatic findings were observed in the intracranial region or skull. Methods: We retrospectively reviewed the medical records and neuroimages of pediatric patients (0–5 years) who presented at our hospital with minor head trauma within 24 h after injury. Results: Of 2405 eligible patients, 1592 (66.2%) underwent CT examinations and 45 (1.9%) had traumatic intracranial hemorrhage or skull fracture on CT. No patient underwent surgery or intensive treatment. Multivariate analyses revealed that an age of 1–5 years (vs. <1 year; P < 0.001), Glasgow Coma Scale (GCS) score of 14 (vs. a score of 15; P = 0.008), sustaining a high-altitude fall (P < 0.001), using an ambulance (P < 0.001), and vomiting (P < 0.001) were significantly associated with the performance of CT examination. In addition, traumatic abnormalities on CT were significantly associated with the combination of an age of under 1 year (P = 0.042), GCS score of 14 (P < 0.001), and sustaining a high-altitude fall (P = 0.004). Conclusion: Although slightly broader indications for CT use, compared to the previous algorithms, could detect and evaluate minor traumatic changes in pediatric patients with minor head trauma, over-indications for CT examinations to detect only approximately 2% of abnormalities should be avoided and the indications should be determined based on the patient’s age, condition, and cause of injury.

Download Full-text

Cochlear Implant Magnet Displacement With Minor Head Trauma

Otolaryngology ◽

10.1016/j.otohns.2005.02.018 ◽

2005 ◽

Vol 133 (2) ◽

pp. 275-277 ◽

Cited By ~ 17

Author(s):

James M. Yun ◽

Michelle W. Colburn ◽

Patrick J. Antonelli

Keyword(s):

Magnetic Resonance Imaging ◽

Cochlear Implants ◽

Head Trauma ◽

Pediatric Patients ◽

Case Series ◽

Minor Head Trauma ◽

Common Complication ◽

Resonance Imaging ◽

Retrospective Case ◽

Young Males

Objectives: Manufacturers have introduced cochlear implants (CIs) with removable magnets to allow for magnetic resonance imaging after placement. The purpose of this study was to describe magnet displacement as a new CI complication and to suggest apossible treatment option to prevent its recurrence. Study Design: Retrospective case series. Methods: The records of 3 young males who experienced CI magnet dislodgement were reviewed and compared against records from the institutional implant database. Results: Magnet displacement was observed only in young males (14% of male children) who received CI with removable magnets. This occurred 13-14 months after CI placement. Magnets were replaced under general anesthesia, and the scalp was bolstered with a dermal allograft. Recurrent magnet dislodgement was encountered in 1 patient, 6 months later. Conclusions: Magnet displacement may be a relatively common complication after minor head trauma in pediatric patients with certain CIs that have removable magnets.

Download Full-text