Comparison of Prediction Rules and Clinician Suspicion for Identifying Children With Clinically Important Brain Injuries After Blunt Head Trauma

Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine
Shireen M AtabakiNathan Kuppermann

Abstract

Children with minor head trauma frequently present to emergency departments (EDs). Identifying those with traumatic brain injuries (TBIs) can be difficult, and it is unknown whether clinical prediction rules outperform clinician suspicion. Our primary objective was to compare the test characteristics of the Pediatric Emergency Care Applied Research Network (PECARN) TBI prediction rules to clinician suspicion for identifying children with clinically important TBIs (ciTBIs) after minor blunt head trauma. Our secondary objective was to determine the reasons for obtaining computed tomography (CT) scans when clinical suspicion of ciTBI was low. This was a planned secondary analysis of a previously conducted observational cohort study conducted in PECARN to derive and validate clinical prediction rules for ciTBI among children with minor blunt head trauma in 25 PECARN EDs. Clinicians recorded their suspicion of ciTBI before CT as <1, 1-5, 6-10, 11-50, or >50%. We defined ciTBI as 1) death from TBI, 2) neurosurgery, 3) intubation for more than 24 hours for TBI, or 4) hospital admission of 2 nights or more associated with TBI on CT. To avoid overfitting of the prediction rules, we performed comparisons of the prediction rules and clini...Continue Reading

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Citations

Jun 24, 2017·European Journal of Trauma and Emergency Surgery : Official Publication of the European Trauma Society·B Nakhjavan-ShahrakiM Hosseini
Sep 19, 2017·Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine·Lorin R BrowneJulie C Leonard
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Dec 29, 2020·Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine·Rajan AroraMichele Nypaver
Feb 9, 2021·Clinical Chemistry and Laboratory Medicine : CCLM·Fleur LortonPauline Scherdel
Mar 7, 2021·The American Journal of Emergency Medicine·Rajan AroraUsha Sethuraman

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