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Identification of Children at Very Low Risk of Clinically-Important Brain Injuries after Head Trauma

Strategic Insights

— 2 min read

Scientists in the United States have conducted a study to identify children at low risk of clinically-important traumatic brain injuries (ciTBI) after head trauma, with the aim of determining whether computed tomography (CT) scans may be unnecessary for these patients. The study involved enrolling patients younger than 18 years presenting within 24 hours of head trauma in 25 North American emergency departments, with a total of 42,412 children enrolled in the study. The researchers derived and validated age-specific prediction rules for ciTBI, which were found to be highly effective in identifying children at very low risk of ciTBI.

Key Takeaways:

  • The study enrolled 42,412 children across 25 North American emergency departments, with 14,969 (35.3%) undergoing CT scans.
  • The prediction rule for children younger than 2 years had a negative predictive value for ciTBI of 1,176/1,176 (100.0%, 95% CI 99.7-100.0) and sensitivity of 25/25 (100%, 86.3-100.0).
  • The prediction rule for children aged 2 years and older had a negative predictive value of 3,798/3,800 (99.95%, 99.81-99.99) and sensitivity of 61/63 (96.8%, 89.0-99.6).
  • 167 (24.1%) of 694 CT-imaged patients younger than 2 years were in the low-risk group, while 446 (20.1%) of 2,223 CT-imaged patients aged 2 years and older were in this group.
  • The researchers concluded that the validated prediction rules identified children at very low risk of ciTBIs for whom CT scans can be routinely obsolete.

Statistics:

  • 42,412 children were enrolled in the study.
  • 14,969 (35.3%) of enrolled children underwent CT scans.
  • 376 (0.9%) of enrolled children experienced ciTBI.
  • 167 (24.1%) of 694 CT-imaged patients younger than 2 years were in the low-risk group.
  • 446 (20.1%) of 2,223 CT-imaged patients aged 2 years and older were in the low-risk group.
  • The prediction rules identified 1,176 (100.0%, 95% CI 99.7-100.0) children as being at very low risk of ciTBI under 2 years old.
  • The prediction rules identified 3,798 (99.95%, 99.81-99.99) children as being at very low risk of ciTBI aged 2 years and older.

Sources:

  • "Identification of children at very low risk of clinically-important brain injuries after head trauma: a prospective cohort study." The Lancet, 2009; 374(9696):1160-70.
  • University of California, Department of Emergency Medicine, Davis School of Medicine, Davis, CA USA.
  • The Emergency Medical Services for Children Programme of the Maternal and Child Health Bureau, and the Maternal and Child Health Bureau Research Programme, Health Resources and Services Administration, US Department of Health and Human Services.

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