Staff | Academic Emergency Medicine

Objectives

To describe the spectrum of head trauma in a pediatric emergency medicine network. For children with minor head trauma, we sought to derive a decision rule to identify patients at very low and high risk for traumatic brain injuries (TBI).

Methods

We prospectively enrolled children -18 years with blunt head trauma at 25 EDs in PECARN from 6/04 to 5/06. Patients with trivial mechanisms were excluded. Head CTs were obtained at the clinician's discretion. Clinical assessment was recorded onto a data form prior to CT results. Patients discharged home were contacted by phone, and medical records of hospitalized patients were reviewed. In patients with minor head trauma (i.e., GCS score 14-15), a decision rule is being developed (using recursive partitioning, with variables with a priori likelihood of association with TBI and with at least moderate interobserver agreement) to identify children at very low and high risk of TBI. Site monitoring and an independent data center insured data quality.

Results

Of 35,140 children enrolled, 62% were boys, and mean age was 6.6 years (SD 5.6). Common mechanisms of injury included falls (48.1%), occupant in motor vehicle crashes (9.1%), ran into stationary objects (8.5%), object struck head (8.4%), sports (7.3%), assaults (7.3%), pedestrians (3.3%) or bicyclists (1.2%) struck by automobiles, and bicycle crashes (3.5%). 96.8% had GCS of 14 (3.1%) or 15 (93.7%). The CTs were obtained in 36.8% (site-specific range: 9.7%-71.1%), and were positive in 11.2% (30% of these were isolated skull fractures). Neurosurgery was performed on 0.5%, and 0.1% died from TBI. For patients with GCS 14-15, a decision rule for TBI will be reported at the meeting.

Conclusions

Blunt head trauma is common in PECARN EDs. Patients are more commonly male, and falls are the dominant mechanism. Most patients have minor head trauma, and CT use is highly variable. A decision rule to identify patients at very low and high risk of TBI may result in more efficient CT use.