Blunt Head Trauma in Children in a Community Health Care Setting: Outcomes and Variables Associated with the Use of Computed Tomography

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• 作者：Patrick J. Van Winkle ; MD¹ ; ^{Patrick.j.vanwinkle@kp.org} ; Ngoc J. Ho ; PhD⁴ ; Casey A. Rodriguez ; MD ; MsPH² ; Laura Sirikulvadhana ; MPH⁴ ; Jane A. McMillan ; MD³
• 关键词：ciTBI ; Clinically-important traumatic brain injury ; CT ; Computed tomography ; ED ; Emergency department ; ICD-9 ; International Classification of Diseases ; 9th revision ; KPOC ; Kaiser Permanente ; Orange County ; PA ; Physician assistant ; PECARN ; Pediatric Emerge
• 刊名：The Journal of Pediatrics
• 出版年：2012
• 出版时间：September, 2012
• 年：2012
• 卷：161
• 期：3
• 页码：547-553.e1
• 全文大小：189 K

文摘

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Objective

To evaluate the incidence of clinically important traumatic brain injury (ciTBI) in children presenting to a community hospital setting and identified factors associated with computed tomography (CT) use.

Study design

Retrospective cohort study of consecutive children presenting with blunt head trauma to a community emergency department or clinic over 12 months. Logistic regression models were used to compare differences in characteristics between patients who received and did not receive CT scans.

Results

Of 1007 patients, 62 % male, age 14 days-18 years (270 <2 years, 737 ¡Ý2 years), 189 (18 % ) had CT scans, 2 (0.2 % ) showed evidence of ciTBI on CT, 13 (1.3 % ) hospitalized, and none required neurosurgical intervention or died. Factors associated with CT use in patients ¡Ý2 years: history of vomiting (OR 4.08, 95 % CI 2.08-7.99, P < .001), change in behavior (OR 2.83, 95 % CI 1.63-4.91, P < .001), headache (OR 3.4, 95 % CI 1.87-6.16, P < .001), loss of consciousness (OR 2.83, 95 % CI 1.38-5.8, P = .004), and abnormal neurologic examination (OR 26.18, 95 % CI 2.26-303.05, P = .009). Patients were more likely to receive CT scans in community emergency departments than clinics (OR 7.04, 95 % CI 2.40-20.65, P = .002).

Conclusion

Patients in our community hospital setting are at low risk of ciTBI. The clinical indicators used to determine the need for CT in patients with more significant mechanisms of injury to pediatric or academic centers may not apply to this group. Future studies are required to determine which clinical indications are significant in this setting.