Pediatric Trauma Society

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Defining Which Children Benefit From Brain Imaging After Trauma... What Are We Willing To Miss
Tammy R Kopelman, Rachel L Alt, Ramin Jamshidi, Paola Pieri, Karole Davis, Sydney J Vail, Iman Feiz erfan, Melissa A Singer Pressman
Maricopa Medical Center, Phoenix, AZ

Background (issue):The PECARN network suggested observation rather than standard brain imaging is an option to exclude traumatic brain injury (TBI) in some children. They reported significant TBI (sTBI) in only 0.9% of children < 2 years of age presenting with normal mental status despite cephalohematoma, loss of consciousness (LOC) ≥ 5 seconds, and/or severe injury mechanism (MOI). We hypothesized that routine imaging in these patients would reveal a greater incidence of sTBI. Methods: After IRB approval, a retrospective review was performed of trauma patients < 2 years of age identified through the trauma registry of a Level 1 Adult/ Level 2 Pediatric Trauma Center over a 5 year timespan. Inclusion criteria included normal mental status after traumatic injury without palpable skull fracture. Significant TBI was defined as death from TBI, need for neurosurgery, or admission ≥ 2 nights associated with TBI. Statistical analysis was performed to determine risk factors for sTBI.
Findings: 124 patients met inclusion criteria. TBI was identified in 32 patients (26%) and deemed significant in 14 patients (15%), with three requiring operation. Risk factors for sTBI included any described LOC (p=0.02) and fall as MOI (p=0.03) but not cephalohematoma (p=ns). While cephalohematoma was not a significant risk factor for sTBI, it was associated with traumatic abnormalities seen on brain CT imaging (p<0.001), most commonly skull fracture (42%).
Conclusions (implications for practice): The risk of significant TBI in patients under 2 years old presenting to a trauma center appears greater than previously described by PECARN providing evidence to support routine brain imaging in this population.


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