scholarly journals Evaluation of Clinical and Radiological Indicators of Childhood Head Trauma

2021 ◽  
Author(s):  
Münevver Yılmaz ◽  
Ayşe Berna Anıl ◽  
Murat Anıl ◽  
Mehmet Helvacı
Keyword(s):  
Traumatic Brain Injury ◽  
Emergency Department ◽  
Brain Injury ◽  
Head Trauma ◽  
Pediatric Emergency ◽  
Pediatric Emergency Department ◽  
Neurological Sequelae ◽  
Neurological Findings ◽  
Blunt Head Trauma

Objective: The aim of this study is to determine the clinical signs of traumatic brain injury and its long-term effects on prognosis by evaluating the clinical and radiological findings of the patients admitted to the pediatric emergency department due to blunt head trauma. Method: The cases who applied to the pediatric emergency department due to head trauma were examined prospectively. Glaskow Coma (GCS) and Pediatric Trauma Scores (PTS) were calculated. The patients were evaluated neurologically 6 months after they were discharged. Results: A total of 707 pediatric patients [mean age: 59.8 ± 42.6 months; range: 1 month to 13 years; 263 (37.2%) girls] were evaluated prospectively. Pathology was detected in 101 cases (45.9%) [(epidural hematoma, 14; subdural hematoma, 11; brain edema, 36; intracerebral hematoma, 6; subarachnoid hemorrhage, 8; cerebral contusion, 22. Seventy-two (10.1%) patients had skull fractures.] Seventeen cases (2.4%) were operated, and 7 (1.4%) cases were lost. In children aged < 2 years vomiting, tachypnea, focal neurological findings, multitrauma, GCS <15 and low PTS were more common with traumatic brain injury (p <0.05). Vomiting, GCS <15 and low PTS were more common in children >2 years old and with traumatic brain injury (p <0.05). Neurological sequelae were not detected in patients aged <2 years with mild trauma. Loss of consciousness, pulse rate, respiratory and blood pressure abnormalities, focal neurological findings, low GCS and PTS were more common in children aged >2 years and with neurological sequelae (p <0.05). Conclusion: Physical examination findings, GCS, and PTS levels are useful tools in predicting the short- and long-term consequences of the injury.

scholarly journals Identification of practically important traumatic brain injury using Pediatric Emergency Care Applied Research Network rule in children younger than 2 years with minor head trauma

2020 ◽  
pp. 102490792097537
Author(s):  
Jon Soo Kim ◽  
Jin Cheol Kim ◽  
Won Young Sung
Keyword(s):  
Traumatic Brain Injury ◽  
Emergency Department ◽  
Brain Injury ◽  
Head Trauma ◽  
Emergency Care ◽  
Applied Research ◽  
Pediatric Emergency ◽  
Research Network ◽  
Minor Head Trauma ◽  
Pediatric Emergency Care

Background: Minor head trauma is frequently presented to the pediatric emergency department. Despite the burden this injury poses on public health, evidence-based clinical guidelines on the assessment and management of pediatric minor head trauma remain unestablished, particularly in children below 2 years. We aimed to assess the diagnostic accuracy of a clinical decision rule (Pediatric Emergency Care Applied Research Network rule) and physician discretion in the recognition of practically important traumatic brain injury in children below 2 years of age presenting with minor head trauma to the emergency department. Methods: The medical records of children younger than 2 years presenting with head trauma to the emergency department were reviewed with Glasgow Coma Scale scores of 14–15. Practically important traumatic brain injury is a clinically essential traumatic brain injury including all cranial abnormalities (e.g. skull fracture) detected by computed tomography. All predictor variables of the Pediatric Emergency Care Applied Research Network rule and practically important traumatic brain injury outcomes were validated. Results: We enrolled and analyzed 433 children below 2 years. The most frequently observed mechanisms of injury in decreasing order were as follows: falls > 90 cm, head struck by high-impact objects, slip down, and automobile traffic accident. Of 224 children, positive findings were observed in 35 and 144 had one or more predictors of Pediatric Emergency Care Applied Research Network rule. The sensitivity, specificity, and negative likelihood ratio of the Pediatric Emergency Care Applied Research Network rule for practically important traumatic brain injury were 94.3%, 41.3%, and 0.14, respectively. Conclusion: The Pediatric Emergency Care Applied Research Network rule would assist in clinical decision-making to appropriately detect potential head injuries in children below 2 years, thereby reducing unnecessary performance of computed tomography scan.

Traumatic brain injury in young children with isolated scalp haematoma

2019 ◽  
Vol 104 (7) ◽  
pp. 664-669 ◽  
Author(s):  
Silvia Bressan ◽  
Amit Kochar ◽  
Ed Oakley ◽  
Meredith Borland ◽  
Natalie Phillips ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Young Children ◽  
Ct Scan ◽  
Head Trauma ◽  
Secondary Analysis ◽  
Predictor Variable ◽  
Pediatric Emergency ◽  
Research Network ◽  
Registration Number

ObjectiveDespite high-quality paediatric head trauma clinical prediction rules, the management of otherwise asymptomatic young children with scalp haematomas (SH) can be difficult. We determined the risk of intracranial injury when SH is the only predictor variable using definitions from the Pediatric Emergency Care Applied Research Network (PECARN) and Children’s Head Injury Algorithm for the Prediction of Important Clinical Events (CHALICE) head trauma rules.DesignPlanned secondary analysis of a multicentre prospective observational study.SettingTen emergency departments in Australia and New Zealand.PatientsChildren <2 years with head trauma (n=5237).InterventionsWe used the PECARN (any non-frontal haematoma) and CHALICE (>5 cm haematoma in any region of the head) rule-based definition of isolated SH in both children <1 year and <2 years.Main outcome measuresClinically important traumatic brain injury (ciTBI; ie, death, neurosurgery, intubation >24 hours or positive CT scan in association with hospitalisation ≥2 nights for traumatic brain injury).ResultsIn children <1 year with isolated SH as per PECARN rule, the risk of ciTBI was 0.0% (0/109; 95% CI 0.0% to 3.3%); in those with isolated SH as defined by the CHALICE, it was 20.0% (7/35; 95% CI 8.4% to 36.9%) with one patient requiring neurosurgery. Results for children <2 years and when using rule specific outcomes were similar.ConclusionsIn young children with SH as an isolated finding after head trauma, use of the definitions of both rules will aid clinicians in determining the level of risk of ciTBI and therefore in deciding whether to do a CT scan.Trial registration numberACTRN12614000463673.

scholarly journals Defining severe traumatic brain injury readmission rates and reasons in a rural state

2018 ◽  
Vol 3 (1) ◽  
pp. e000186 ◽  
Author(s):  
James Gardner ◽  
Kevin W Sexton ◽  
John Taylor ◽  
William Beck ◽  
Mary Katherine Kimbrough ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Chronic Diseases ◽  
Head Trauma ◽  
Motor Vehicle ◽  
Level Of Evidence ◽  
Data Set ◽  
Discharge Data ◽  
Long Term Treatment

BackgroundReadmissions after a traumatic brain injury (TBI) have significant impact on long-term patient outcomes through interruption of rehabilitation. This study examined readmissions in a rural population, hypothesizing that readmitted patients after TBI will be older and have more comorbidities than those not readmitted.MethodsDischarge data on all patients 15 years and older who were admitted to an Arkansas-based hospital for TBI were obtained from the Arkansas Hospital Discharge Data System from 2010 to 2014. This data set includes diagnoses (principal discharge diagnosis, up to 3 external cause of injury codes, 18 diagnosis codes using the International Classification of Disease, 9th Edition, Clinical Modifications), age, gender, and inpatient costs. Hospital Cost and Utilization Project Clinical Classification and Chronic Condition Indicator were used to identify chronic disease and body systems affected in principal diagnosis.ResultsOf the 3114 cases of significant head trauma, more than two-thirds were attributed to fall injuries, with motor vehicle crashes accounting for 20% of the remainder. The mean length of stay was 6.5 days. 691 of these patients were admitted to an Arkansas hospital in the following year, totaling 1368 readmissions. Of the readmissions, 16.4% of patients were admitted for altered mental status, 12.9% with shortness of breath (SOB), and 9.4% with chest pain. Mental disorders (psychosis, dementia, and depression) and organic nervous symptoms (Alzheimer’s disease, encephalopathy, and epilepsy) were the primary source of readmissions. More than one-third of the patients were admitted in the following year for chronic diseases such as heart failure (8.6%), psychosis (5.2%), and cerebral artery occlusion (4.1%).DiscussionThis study showed that there is a significant rate of readmissions in the year after a diagnosis of TBI. Complications with existing chronic diseases are among the most reported reasons for admission in this time period, demonstrating the effect severe head trauma has on long-term treatment.Level of evidenceLevel IV, Retrospective epidemiological study.

Traumatic Brain Injury

2021 ◽  
pp. 489-500
Author(s):  
Lucas P. Carlstrom ◽  
Eelco F. M. Wijdicks
Keyword(s):  
United States ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Head Trauma ◽  
The United States ◽  
Diagnostic Approach ◽  
Intracranial Hemorrhages ◽  
Personal Costs

Traumatic brain injury (TBI) continues to be a leading cause of long-term morbidity and death worldwide. Each year, an estimated 1.7 million persons in the United States sustain TBIs, leading to 275,000 hospitalizations and 52,000 deaths annually. In addition to high personal costs, the direct and indirect societal expenditures are estimated to be $60 billion per year. This chapter reviews the diagnostic approach to head trauma and prognosis in brain injury and addresses specific conditions, such as concussions and intracranial hemorrhages.

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