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 Vol. 20 No. 2, August 2008
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AAP Grand Rounds 20:14-15 (2008)
© 2008 American Academy of Pediatrics

CRITICAL CARE/EMERGENCY MEDICINE

When to Use Computed Tomography in Minor Pediatric Head Trauma

Source: Atabaki SM, Stiel I, Bazarian JJ, et al. A clinical decision rule for cranial computed tomography in minor pediatric head trauma. Arch Ped Adol Med. 2008;162(5):439–445; doi:10.1001/archpedi.162.5.439[Abstract/Free Full Text]

The first 20% of the full text of this article appears below.


PICO

Question: Among children with minor head trauma can a sensitive clinical decision rule be developed that has a high negative predictive value to enable more limited use of cranial computed tomography?

Question type: Screening

Study design: Prospective observational study

 

The investigators for this study prospectively enrolled 1,000 children (0–21 years old) who were treated for minor head trauma in the emergency department (ED) at one of four participating level I pediatric trauma centers between 1997 and 2000.

Minor head trauma was defined as a history of a loss of consciousness (LOC) or posttraumatic amnesia and a Glasgow Coma Scale (GCS) score greater than 12. Before cranial computerized tomography (CT) scanning, patients were examined for evidence of dizziness, amnesia, headache, intoxication, seizure, vomiting, change in behavior, palpable scalp defect, basilar skull fracture, sensory or motor deficits as well as history and duration of LOC. The primary outcome was intracranial injury documented on CT with need for neurosurgical intervention. Prior to the test, examining physicians predicted if they expected the CT to have abnormal findings. Recursive partitioning was used in the analysis, with the goal of developing a clinical decision-making tool that was very sensitive and had a high negative predictive value for intracranial injury.

The mean patient age was 8.9 years and 64% were male. Nineteen percent of patients were under two years of age. Sixty-five of 1,000 patients had intracranial injury on the cranial CT, and six of these required a neurosurgical intervention. The intracranial injury features that predicted need for a CT . . . [Full Text of this Article]

Susan L. Bratton, MD, MPH, FAAP1
1 Pediatric Critical Care Medicine, Primary Children’s Medical Center, University of Utah Health Sciences Center, Salt Lake City, UT

 
Ronald I. Paul, MD, FAAP2
2 Pediatric Emergency Medicine, Kosair Children’s Hospital, University of Louisville, Louisville, KY