• About
  • Masthead
  • License Content
  • Advertise
  • Submit Press Release
  • RSS/Email List
  • Write for us
  • Contact us
2 Minute Medicine
No Result
View All Result

No products in the cart.

SUBSCRIBE
  • Specialties
    • Cardiology
    • Chronic Disease
    • Dermatology
    • Emergency
    • Endocrinology
    • Gastroenterology
    • Imaging and Intervention
    • Infectious Disease
    • Nephrology
    • Neurology
    • Obstetrics
    • Oncology
    • Ophthalmology
    • Pediatrics
    • Preclinical
    • Psychiatry
    • Public Health
    • Pulmonology
    • Rheumatology
    • Surgery
  • The Scan
  • Wellness
  • Classics™
    • 2MM+ Online Access
    • Paperback and Ebook
  • Rewinds
  • Visual
  • Partners
    • License Content
    • Submit Press Release
    • Advertise with Us
  • AccountLog-in/out
    • Subscribe
    • Sign-in
    • My account
2 Minute Medicine
  • Specialties
    • Cardiology
    • Chronic Disease
    • Dermatology
    • Emergency
    • Endocrinology
    • Gastroenterology
    • Imaging and Intervention
    • Infectious Disease
    • Nephrology
    • Neurology
    • Obstetrics
    • Oncology
    • Ophthalmology
    • Pediatrics
    • Preclinical
    • Psychiatry
    • Public Health
    • Pulmonology
    • Rheumatology
    • Surgery
  • The Scan
  • Wellness
  • Classics™
    • 2MM+ Online Access
    • Paperback and Ebook
  • Rewinds
  • Visual
  • Partners
    • License Content
    • Submit Press Release
    • Advertise with Us
  • AccountLog-in/out
    • Subscribe
    • Sign-in
    • My account
SUBSCRIBE
2 Minute Medicine
Subscribe
Home All Specialties Emergency

Clinical decision tool may discriminate need for ICU in children with traumatic brain injury and intracranial injury

byShayna BejaimalandAnees Daud
February 15, 2017
in Emergency, Imaging and Intervention, Pediatrics, Public Health, Surgery
Reading Time: 3 mins read
0
Share on FacebookShare on Twitter

1. Based on this secondary analysis of a prospective cohort study, certain clinical features, including lower GCS score, and head CT findings, including midline shift, depressed skull fracture and epidural hematoma, were predictive of need for intensive care unit (ICU) in children with mild traumatic brain injury and intracranial injury.

2. The Children’s Intracranial Injury Decision Aid (CHIIDA) score (0 to 24 points) was based on the aforementioned factors, and had a negative predictive value (NPV) of requiring ICU with 0 points of 98.8%. Any score greater than zero, however, was not helpful in determining the appropriate disposition for the patient, meaning that there may still be an overuse of resources when using this tool.

Evidence Rating Level: 2 (Good)

Study Rundown: There has been an increasing understanding of the risks and consequences of mild traumatic brain injury (mTBI) and intracranial injury (ICI). However appropriate, evidence-based risk assessment scores to be used with computer tomographic (CT) imaging have not been created. These scores may improve patient safety and appropriation of resources. This retrospective analysis of the Pediatric Emergency Care Applied Research Network (PECARN) head injury cohort study aimed to derive a risk score predicting the need for the ICU in children with mTBI and ICI.

For the composite outcome of need for ICU, neurosurgical intervention, intubation, and death from TBI, the only clinically significant variable was lower GCS score. CT head predictors included midline shift, presence of a depressed skull fracture, and epidural hematoma. Using this data, the authors created the Children’s Intracranial Injury Decision Aid (CHIIDA) score, ranging from 0 to 24 points. The NPV of requiring the ICU with score 0 points was 98.8%. The strength of this study was the use of a large pediatric cohort. However, the poor positive predictive value of the score limits its use in determining the disposition for many of the patients with mTBI and ICI.

Click to read the study, published in JAMA Pediatrics

Relevant Reading: Trends in Hospitalizations Associated With Pediatric Traumatic Brain Injuries

RELATED REPORTS

BNT162b2 COVID-19 vaccine safe and efficacious in young children

High-protein supplementation improves linear growth in infants

Kocher Criteria differentiates pediatric septic arthritis and transient synovitis of the hip [Classics Series]

In-Depth [retrospective cohort study]: The PECARN is a prospective pediatric head injury cohort that enrolled patients from 25 North American emergency departments from 2004 to 2006. These patients were 18 years or younger with mTBI (GCS13-15) and ICI found on CT. The cohort data was analyzed for the primary composite outcome of neurosurgical intervention, intubation for more than 24 hours for TBI, or death from TBI. The data was analyzed from May 2015 to October 2016 using multivariate logistic regression to identify risk factors that accurately predicted this outcome. The C-statistic was then used to determine the model’s performance and accuracy by examining both discrimination and calibration. The risk score was internally validated using 10-fold cross-validation methods. This led to the Children’s Intracranial Injury Decision Aid (CHIIDA) score.

Of the 15 162 children with GCS 13-15 head injuries, 839 (5.5%) had ICI. Of those, only 73 (8.7%) experienced the primary outcome. Within this sample, risk factors associated with the primary outcome were: GCS score (OR 3.4; 95% CI 1.5-7.4 for GCS score 13 vs 15), midline shift on CT (OR 6.8; 95% CI 3.4-13.8), depressed skull fracture (OR 6.5; 95% CI 3.7-11.4) and epidural hematoma (OR 3.4; 95% CI 1.8-6.2). The model C-statistic was 0.84. The CHIIDA score ranged from 0-24 points: midline shift, 7 points; depressed skull fracture, 7 points; epidural hematoma, 5 points, GCS of 13, 5 points; GCS of 14, 2 points. In predicting need for ICU admission, a cut off of >0 points was used to suggest admission to ICU with a sensitivity of 93.2%, NPV of 98.8%. Using this cutoff, the authors suggested that 51.3% ICU admissions would be avoided. Using a cutoff of 2 points the authors suggested that 65.4% of ICU admissions would be avoided. The CHIIDA score, however, was not able to accurately discriminate disposition.

Image: PD

©2017 2 Minute Medicine, Inc. All rights reserved. No works may be reproduced without expressed written consent from 2 Minute Medicine, Inc. Inquire about licensing here. No article should be construed as medical advice and is not intended as such by the authors or by 2 Minute Medicine, Inc.

Tags: brain injurypediatric
Previous Post

Polygenic index of waist-hip ratio associated with cardiovascular disease

Next Post

JAK 1 and 2 inhibitor superior to adalimumab in treatment of rheumatoid arthritis: The RA-BEAM trial

RelatedReports

AAP recommends disaster preparedness measures for children
Infectious Disease

BNT162b2 COVID-19 vaccine safe and efficacious in young children

February 23, 2023
Ear infections decreasing in infants
Pediatrics

High-protein supplementation improves linear growth in infants

January 30, 2023
The ABCD2 score: Risk of stroke after Transient Ischemic Attack (TIA) [Classics Series]
Pediatrics Classics

Kocher Criteria differentiates pediatric septic arthritis and transient synovitis of the hip [Classics Series]

September 19, 2022
Study evaluates family-initiated medication dialogues on rounds
Emergency

Adenovirus infection associated with hepatitis of unknown cause in children

August 25, 2022
Next Post
Non-TNF-targeted therapies more effective than anti-TNF agents in uncontrolled rheumatoid arthritis

JAK 1 and 2 inhibitor superior to adalimumab in treatment of rheumatoid arthritis: The RA-BEAM trial

High incidence of foreskin morbidity in uncircumcised males

Bariatric surgery superior to medical therapy for diabetes at five-years: The STAMPEDE trial

Tonsillectomy may have short-term benefits in recurrent throat infection

AAP releases 2017 recommendations for preventive pediatric health care

License Our Award-Winning Physician-Written Medical News and Visual Abstracts

2 Minute Medicine is the leading authoritative medical news licensing service, and the only with reports written by practicing doctors.

LICENSE CONTENT

2MM+ Premium Access

No ads & unlimited access to all current reports, over 9000 searchable archived reports, visual abstracts, Weekly Rewinds, and the online edition of The Classics Series™ textbook.

Subscription Options
2 Minute Medicine

2 Minute Medicine® is an award winning, physician-run, expert medical media company. Our content is curated, written and edited by practicing health professionals who have clinical and scientific expertise in their field of reporting. Our editorial management team is comprised of highly-trained MD physicians. Join numerous brands, companies, and hospitals who trust our licensed content.

Recent Reports

  • Expectant management of patent ductus arteriosus noninferior to early ibuprofen use
  • Exhaled volatile organic compounds predict bronchopulmonary dysplasia in preterm infants
  • Wellness Check: Mental Health
License Content
Terms of Use | Disclaimer
Cookie Policy
Privacy Statement (EU)
Disclaimer

© 2021 2 Minute Medicine, Inc. - Physician-written medical news.

  • Specialties
    • Cardiology
    • Chronic Disease
    • Dermatology
    • Emergency
    • Endocrinology
    • Gastroenterology
    • Imaging and Intervention
    • Infectious Disease
    • Nephrology
    • Neurology
    • Obstetrics
    • Oncology
    • Ophthalmology
    • Pediatrics
    • Preclinical
    • Psychiatry
    • Public Health
    • Pulmonology
    • Rheumatology
    • Surgery
  • The Scan
  • Wellness
  • Classics™
    • 2MM+ Online Access
    • Paperback and Ebook
  • Rewinds
  • Visual
  • Partners
    • License Content
    • Submit Press Release
    • Advertise with Us
  • Account
    • Subscribe
    • Sign-in
    • My account

© 2021 2 Minute Medicine, Inc. - Physician-written medical news.

Want more physician-written
medical news?

Join over 10 million yearly readers and numerous companies. For healthcare professionals
and the public.

Subscribe for free today!

Subscription options