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Updated: Jul 20, 2026
A Bedside, Single Burr Hole Approach to Multimodality Monitoring in Severe Brain Injury
Published on: March 26, 2019
[Management of isolated minor head trauma. A multicenter study]
O Bello Pedrosa1, J Prego Petit, J Stewart Davies
1Departamento de Emergencia Pediátrica, Centro Hospitalario Pereira Rossell, Montevideo, Uruguay. dptechp@chasque.apc.org
Insights
This study found that a decision tree effectively detects intracranial injuries (ICI) in children with minor head trauma, ensuring proper management and early diagnosis. The protocol achieved early detection in all identified cases.
Area of Science:
- Pediatric Emergency Medicine
- Neurotrauma
- Clinical Decision Support Systems
Context:
- Minor head trauma is common in children presenting to emergency departments.
- Accurate and timely diagnosis of intracranial injuries (ICI) is crucial for optimal patient outcomes.
- Existing diagnostic approaches may lead to overtreatment or missed diagnoses.
Purpose:
- To evaluate the effectiveness of a previously established decision tree for the early detection of intracranial injuries (ICI) in pediatric patients with minor head trauma.
- To assess the accuracy of classification and appropriateness of management based on the decision tree protocol.
- To determine the incidence of ICI and neurosurgical intervention in different risk categories.
Summary:
- A prospective multicenter study included 2148 children (3 months to 14 years) with minor head trauma (Glasgow Coma Scale 13-15).
- Patients were stratified into low, intermediate, and high-risk groups based on age and clinical factors, guiding management recommendations (home observation, hospital observation, or CT scan).
- The decision tree protocol resulted in proper classification for 90.1% of patients and appropriate management in 87.4%, with early detection of ICI in all positive cases, predominantly in the high-risk group.
Impact:
- The study demonstrates that implementing a structured decision tree protocol can significantly improve the early and accurate detection of intracranial injuries in pediatric head trauma.
- This approach aids in optimizing resource utilization by identifying children who require advanced imaging (CT) versus those who can be safely observed.
- The findings support the broader adoption of evidence-based clinical decision support tools in pediatric emergency care to enhance diagnostic accuracy and patient safety.
Objective:
To detect intracranial injuries (ICI) earlier in children with minor head trauma through the use of a previously established decision tree.
Method:
We performed a prospective multicenter study from September 2003 to January 2005. All patients aged between 3 months and 14 years old who visited the emergency department with minor head trauma (Glasgow Coma Scale score 13-15) were included. Six situations were established according to age (older or younger than 2 years) and low, intermediate or high risk for ICI. The management of each situation was suggested: observation at home, hospital observation or computed tomography (CT). The records of all patients were audited and categorized into: "properly classified, correct management", "properly classified but incorrect management", and "wrongly classified". All the patients were followed-up after discharge.
Results:
A total of 2148 patients were included. Low risk was assigned to 54.8 %, intermediate risk to 32.4 %, and high risk to 12.8 %. Observation at home or in hospital was assigned to 53.4 % and 24 % respectively. CT was performed in 22.6 %. ICI was detected in 1.6 % and 0.32 % required neurosurgery. There were 25 ICI in the high risk group, seven in the intermediate risk group, and none in the low risk group. No ICI were detected during follow-up. Most patients (90.1 %) were properly classified and the proposed management was carried out in 87.4 %.
Conclusions:
When the recommendations of the management protocol were applied, early detection of ICI was achieved in all the situations in which these lesions occurred.
