Skip to main content

Advertisement

SpringerLink
Log in

Predictors of intracranial injuries in children after blunt head trauma

  • Original Paper
  • Published:
European Journal of Pediatrics Aims and scope Submit manuscript

Abstract

This study was conducted to determine if clinical features can predict the risk of intracranial injury (ICI) in pediatric closed head trauma. We enrolled 3,806 children under 16 years consecutively referred for acute closed head trauma to the paediatric emergency room of five Italian children’s hospitals. Relevant outcomes were death and diagnosis of ICI. Clinical symptoms and signs were evaluated as possible outcome predictors. Children were also classified into five groups according to their clinical presentation. The association of ICI with signs and symptoms and the appropriateness of the five-group classification in predicting the likelihood of ICI were evaluated by logistic regression analyses. ICI was diagnosed in 22 children; 2 of them died. The risk of fatal and nonfatal ICI was 0.5 and 5.2 per 1,000 children with closed head trauma respectively. Significant associations were found between ICI and loss of consciousness, prolonged headache, persistent drowsiness, abnormal mental status, focal neurological signs, signs of skull fracture in non-frontal areas and signs of basal skull fracture. The five-group classification of children allowed an excellent prediction in terms of likelihood of ICI (ROC area 0.972). Conclusions: Selection of children with closed head trauma based on different combinations of signs and symptoms allows for early identification of subjects at different risk for ICI. In patients with minor head injuries, the absence of loss of consciousness, drowsiness, amnesia, prolonged headache, clinical evidence of basal or non-frontal skull fracture identified 100% of children without lesions. Validation of our results with a larger sample of patients with ICI would be highly desirable.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Abbreviations

ICI:

Intracranial Injury

ROC:

Receiver operating characteristic

ED:

Emergency department

References

  1. Langlois JA (2001) Traumatic brain injury in the United States: assesing outcomes in children. National Center for Injury Prevention and Contro, Atlanta, GA, pp 1–50

    Google Scholar 

  2. ISTAT (2000) Cause di morte http://www.istat.it/Prodotti-e/Allegati1/Cause-di-m6/volumeII.pdf Last accessed October 18, 2004

  3. Dietrich AM, Bowman MJ, Ginn–Pease ME, Kosnik E, King DR (1993) Pediatric head injuries: can clinical factors reliably predict an abnormality on computed tomography? Ann Emerg Med 22:1535–1540

    Article  PubMed  CAS  Google Scholar 

  4. Benito Fernandez J, Mintegui Raso S, Sanchez Echaniz J, Martines Gonzalez MJ, Fernandez Questa MA (1998) Head injuries in children: can clinical features identify patients with high or low risk for intracranical injury? An Esp Pediatr 48:122–126

    PubMed  CAS  Google Scholar 

  5. Homer CJ, Kleinman L (1999) Technical report: minor head injury in children. Pediatrics 104(6):e78

    Article  PubMed  CAS  Google Scholar 

  6. Schutzman SA, Greens DS (2001) Pediatric minor head trauma. Emerg Med 37:65–74

    CAS  Google Scholar 

  7. Palchak MJ, Holmes JF, Vance CW, Gelber ER, Shauer BA, Harrison MJ, Willis-Shore J, Wootton-Gorges SL, Derlet RW, Kupperman N (2003) A decision rule for identifying children at low risk for brain injures after blunt head trauma. Ann Em Med 42:492–506

    Article  Google Scholar 

  8. Greenes DS (2003) Decision making in pediatric minor head trauma. Ann Em Med 42:515–518

    Article  Google Scholar 

  9. Dunning J, Batchelor J, Stratford-Smith P, Teece S, Browne J, Sharpin C, Mackway-Jones K (2003) A meta-analysis of variables that predict significant intracranial injury in minor head trauma. Arch Dis Child 89:653–659

    Article  Google Scholar 

  10. Kuppermann N (2004) Intracranial injury in minor head trauma. Arch Dis Child 89:593–594

    Article  PubMed  CAS  Google Scholar 

  11. American Academy of Pediatrics (1999) The management of minor closed head injury in children. Pediatrics 104:1407–1415

    Article  Google Scholar 

  12. Schutzmann SA, Barnes P, Duhaime AC, Greens D, Homer C, Jaffe D, Lewis RJ, Luerssen TG, Shunk J (2001) Evaluation and management of children younger than two years old with apparently minor head trauma: proposed guidelines. Pediatrics 107:983–993

    Article  Google Scholar 

  13. Davis RL, Hughes M, Gubler D, Waller PL, Rivara FP (1995) The use of cranial CT scans in the triage of pediatric patients with mild head injury. Pediatrics 95:345–349

    PubMed  CAS  Google Scholar 

  14. Quayle K, Jaffe D, Kuppermann N, Kaufman BA, Lee BC, Park TS, McAlister WH (1997) Diagnostic testing for acute head injury in children: when are head computed tomography and skull radiographs indicated? Pediatrics 99:E11

    Article  PubMed  CAS  Google Scholar 

  15. Roddy S, Cohn S, Moller B, Duncan CC, Gosche JR, Seashore JH, Touloukian RJ (1998) Minimal head trauma in children revisited: is routine hospitalization required? Pediatrics 101:575–577

    Article  PubMed  CAS  Google Scholar 

  16. Haydel MJ, Preston CA, Mills TJ, Luber S, Blaudeau E, De Blieux PM (2000) Indications for computed tomography in patients with minor head injury. N Engl J Med 343:100–105

    Article  PubMed  CAS  Google Scholar 

  17. Murgio A, Patrick PD, Andrade FA, Boetto S, Leung KM, Munoz Sanches MA (2001) International study of emergency department care for pediatric traumatic brain injury and the role of CT scanning. Child Nerv Syst 17:257–262

    Article  CAS  Google Scholar 

  18. Glasgow JF, McGovern SJ (2000) Imaging in less serious head injuried child. Arch Dis Child 82:333–335

    Article  PubMed  CAS  Google Scholar 

  19. Le Hors–Albouze H (2003) Traumatismes craniens dits benins de l’enfant: surveillance clinique ou tomodensitométrie cérébrale systématique? Management of minor head in children. Arch Pédiatr 10:82–96

    Article  PubMed  Google Scholar 

  20. James HE (1986) Neurologic evaluation and support in the child with acute brain insult. Pediatr Ann 15:16–22

    PubMed  CAS  Google Scholar 

  21. Begg C (1991) Advances in statistical methodology for diagnostic medicine in the 1980s. Stat Med 10:1887–1895

    Article  PubMed  CAS  Google Scholar 

  22. Brenner DJ, Elliston CD, Hall EJ, Berdon WE (2001) Estimated risks of radiation-induced fatal cancer from pediatric CT. Am H Roentgenol 176:289–296

    CAS  Google Scholar 

  23. Brenner DJ (2002) Estimating cancer risk from pediatric CT: going from the qualitative to the quantitative. Pediatr Radiol 32:228–233

    Article  PubMed  Google Scholar 

  24. Rosenthal BW, Bergman I (1989) Intracranial injury after moderate head trauma in children. J Pediatr 115:346–350

    Article  PubMed  CAS  Google Scholar 

  25. Wang MY, Griffith P, Sterling J, McComb JG, Levy ML (2000) A prospective population-based study of pediatric trauma patients with mild alterations in consciousness. Neurosurgery 46:1093–1099

    Article  PubMed  CAS  Google Scholar 

  26. Batchelor J, Mc Guiness A (2002) A meta-analysis of GCS 15 head injured patients with loss of consciouness or post-traumatic amnesia. Emerg Med J 19:515–519

    Article  PubMed  CAS  Google Scholar 

  27. Haydel MJ, Shembekar AD (2003) Prediction of intracranial injury in children aged five years and older with loss of consciousness after minor head injury due to nontrivial mechanisms. Ann Em Med 42:507–514

    Article  Google Scholar 

  28. Palchak MJ, Holmes JF, Vance CW, Gelber ER, Shauer BA, Harrison MJ, Willis-Shore J, Wootton-Gorges SL, Derlet RW, Kupperman N (2004) Does an isolated history of loss of consciousness or amnesia predict brain injuries in children after blunt head trauma? Pediatrics 113:e507–e513

    Article  PubMed  Google Scholar 

  29. Holmes JF, Palchak MJ, Conklin MJ, Kuppermann N (2004) Do children require hospitalization after immediate posttraumatic seizures? Ann Emerg Med 43:706–710

    Article  PubMed  Google Scholar 

  30. Schunk JE, Rodgerson JD, Woodward GA (1996) The utility of head computed tomographic scanning in pediatric patients with normal neurologic examination in the emergency department. Pediatr Emerg Care 12:160–165

    Article  PubMed  CAS  Google Scholar 

  31. Gruskin KD, Schutzman SA (1999) Head trauma in children younger than 2 years. Are there predictors for complications? Arch Pediatr Adolesc Med 153:15–20

    PubMed  CAS  Google Scholar 

  32. Jan MMS, Camfield PR, Gordon K, Camfield CS (1997) Vomiting after mild head injury is related to migraine. J Pediatr 130:134–137

    Article  PubMed  CAS  Google Scholar 

  33. Brown FD, Brown J, Beattie TF (2000) Why do children vomit after minor head injury? J Accid Emerg Med 17:268–271

    PubMed  CAS  Google Scholar 

  34. Greenes DS, Schutzman SA (1999) Clinical indicators if intracranial injury in head-injured infants. Pediatrics 104:861-867

    Article  PubMed  CAS  Google Scholar 

  35. Dunning J, Daly JP, Malhotra R, Stratford-Smith P, Lomas JP, lecky F, Batchelor J, Mackway-Jones K, for CHALICE Study (2004) The implications of NICE guidelines on the management of children presenting with head injury. Arch Dis Child 89:763–767

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgement

We thank professor Graziano Cagnoni, from the Department of Neurosurgery, Ospedale Mayer, Firenze, who greatly contributed to the realisation of this work.

Author information

Authors and Affiliations

  1. Dipartimento di Pediatria, Università di Padova, Via Giustiniani 3, 35128, Padova, Italy

    Liviana Da Dalt & Lucia Pavanello

  2. IRCCS Burlo Garofolo Trieste, Trieste, Italy

    Alberto G. Marchi & Gianni Messi

  3. Clinica Pediatrica, Università di Modena, Modena, Italy

    Lorenzo Laudizi

  4. Clinica Pediatrica, Università di Udine, Udine, Italy

    Giovanni Crichiutti

  5. Cattedra di Igiene ed Epidemiologia, Università di Udine, Udine, Italy

    Francesca Valent & Fabio Barbone

Authors
  1. Liviana Da Dalt
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Alberto G. Marchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Lorenzo Laudizi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Giovanni Crichiutti
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Gianni Messi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Lucia Pavanello
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Francesca Valent
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Fabio Barbone
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Liviana Da Dalt.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Da Dalt, L., Marchi, A.G., Laudizi, L. et al. Predictors of intracranial injuries in children after blunt head trauma. Eur J Pediatr 165, 142–148 (2006). https://doi.org/10.1007/s00431-005-0019-6

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00431-005-0019-6

Keywords

Search

Navigation