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A meta-analysis of variables that predict significant intracranial injury in minor head trauma
  1. J Dunning1,
  2. J Batchelor1,
  3. P Stratford-Smith1,
  4. S Teece1,
  5. J Browne2,
  6. C Sharpin3,
  7. K Mackway-Jones1
  1. 1for the Emergency Medicine Research Group (EmeRGe), Manchester Royal Infirmary, UK
  2. 2Health Services Research Unit, London School of Hygiene and Tropical Medicine, London, UK
  3. 3Royal College of Surgeons of England, London, UK
  1. Correspondence to:
    Mr J Dunning
    Department of Emergency Medicine, Manchester Royal Infirmary, Oxford Road, Manchester M13 3BW, UK;


Background: Previous studies have presented conflicting results regarding the predictive effect of various clinical symptoms, signs, and plain imaging for intracranial pathology in children with minor head injury.

Aims: To perform a meta-analysis of the literature in order to assess the significance of these factors and intracranial haemorrhage (ICH) in the paediatric population.

Methods: The literature was searched using Medline, Embase, Experts, and the grey literature. Reference lists of major guidelines were crosschecked. Control or nested case-control studies of children with head injury who had skull radiography, recording of common symptoms and signs, and head computed tomography (CT) were selected. Outcome variable: CT presence or absence of ICH.

Results: Sixteen papers were identified as satisfying criteria for inclusion in the meta-analysis, although not every paper contained data on every correlate. Available evidence gave pooled patient numbers from 1136 to 22 420. Skull fracture gave a relative risk ratio of 6.13 (95% CI 3.35 to 11.2), headache 1.02 (95% CI 0.62 to 1.69), vomiting 0.88 (95% CI 0.67 to 1.15), focal neurology 9.43 (2.89 to 30.8), seizures 2.82 (95% CI 0.89 to 9.00), LOC 2.23 (95% CI 1.20 to 4.16), and Glasgow Coma Scale (GCS) <15 of 5.51 (95% CI 1.59 to 19.0).

Conclusions: There was a statistically significant correlation between intracranial haemorrhage and skull fracture, focal neurology, loss of consciousness, and GCS abnormality. Headache and vomiting were not found to be predictive and there was great variability in the predictive ability of seizures. More information is required about the current predictor variables so that more refined guidelines can be developed. Further research is currently underway by three large study groups.

  • CT, computed tomography
  • GCS, Glasgow Coma Scale
  • ICH, intracranial haemorrhage
  • craniocerebral trauma
  • head injury
  • brain injury
  • meta-analysis

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  • Funding for this study was provided solely by the Royal College of Surgeons of England. We are grateful for the support of the Enid Linder Research Fellowship from the RCS. None of the authors receive additional funding from any commercial companies.

  • The authors certify that they have no affiliations with any other organisations or companies other than those mentioned in the manuscript, that might unduly influence the findings of this study.

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