Mild traumatic brain injury in children with ventricular shunts: a PREDICT study

Author:

Babl Franz E.123,Lyttle Mark D.245,Phillips Natalie6,Kochar Amit7,Dalton Sarah8,Cheek John A.1293,Furyk Jeremy101112,Neutze Jocelyn13,Bressan Silvia214,Williams Amanda2,Hearps Stephen J. C.,MBiostat 2,Oakley Ed123,Davis Gavin A.2,Dalziel Stuart R.1516,Borland Meredith L.1718

Affiliation:

1. Emergency Department, Royal Children’s Hospital, Melbourne;

2. Murdoch Children’s Research Institute, Melbourne, Victoria, Australia;

3. Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria, Australia

4. Emergency Department, Bristol Royal Hospital for Children, Bristol;

5. Faculty of Health and Life Sciences, University of the West of England, Bristol, United Kingdom;

6. Emergency Department, Queensland Children’s Hospital, and Child Health Research Centre, Faculty of Medicine, The University of Queensland, South Brisbane;

7. Emergency Department, Women’s and Children’s Hospital, Adelaide;

8. Emergency Department, The Children’s Hospital at Westmead, Sydney;

9. Emergency Department, Monash Medical Centre, Melbourne;

10. Emergency Department, The Townsville Hospital, Townsville;

11. Emergency Department, University Hospital Geelong;

12. School of Medicine, Faculty of Health, Deakin University, Geelong, Victoria, Australia;

13. Emergency Department, KidzFirst Middlemore Hospital, Auckland, New Zealand;

14. Department of Women’s and Children’s Health, University of Padova, Italy;

15. Emergency Department, Starship Children’s Health, Auckland;

16. Departments of Surgery and Paediatrics, Child and Youth Health, University of Auckland, New Zealand; and

17. Emergency Department, Perth Children’s Hospital;

18. School of Medicine, Divisions of Emergency Medicine and Paediatrics, University of Western Australia, Perth;

Abstract

OBJECTIVECurrent clinical decision rules (CDRs) guiding the use of CT scanning in pediatric traumatic brain injury (TBI) assessment generally exclude children with ventricular shunts (VSs). There is limited evidence as to the risk of abnormalities found on CT scans or clinically important TBI (ciTBI) in this population. The authors sought to determine the frequency of these outcomes and the presence of CDR predictor variables in children with VSs.METHODSThe authors undertook a planned secondary analysis on children with VSs included in a prospective external validation of 3 CDRs for TBI in children presenting to 10 emergency departments in Australia and New Zealand. They analyzed differences in presenting features, management and acute outcomes (TBI on CT and ciTBI) between groups with and without VSs, and assessed the presence of CDR predictors in children with a VS.RESULTSA total of 35 of 20,137 children (0.2%) with TBI had a VS; only 2 had a Glasgow Coma Scale score < 15. Overall, 49% of patients with a VS underwent CT scanning compared with 10% of those without a VS. One patient had a finding of TBI on CT scanning, with positive predictor variables on CDRs. This patient had a ciTBI. No patient required neurosurgery. For children with and without a VS, the frequency of ciTBI was 2.9% (95% CI 0.1%–14.9%) compared with 1.4% (95% CI 1.2%–1.6%) (difference 1.5% [95% CI −4.0% to 7.0%]), and TBI on CT 2.9% (95% CI 0.1%–14.9%) compared with 2.0% (95% CI 1.8%–2.2%) (difference 0.9%, 95% CI −4.6% to 6.4%).CONCLUSIONSThe authors’ data provide further support that the risk of TBI is similar for children with and without a VS.

Publisher

Journal of Neurosurgery Publishing Group (JNSPG)

Subject

General Medicine

Cited by 4 articles. 订阅此论文施引文献 订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献

1. Management of patients suffering from mild traumatic brain injury 2023;Anaesthesia Critical Care & Pain Medicine;2023-08

2. Incidence of traumatic brain injuries in head‐injured children with seizures;Emergency Medicine Australasia;2022-11-02

3. Return to play in children with shunted hydrocephalus;Journal of Neurosurgery: Pediatrics;2022-01-01

4. Australian and New Zealand Guideline for Mild to Moderate Head Injuries in Children;Emergency Medicine Australasia;2021-02-02

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