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Intracranial hemorrhage after blunt head trauma in children with bleeding disorders

Lois K Lee1, Peter S Dayan, Michael J Gerardi

  • 1Department of Pediatrics, Harvard Medical School, Boston, MA, USA.

The Journal of Pediatrics
|January 15, 2011
PubMed

Insights

Children with bleeding disorders had higher computerized tomography (CT) use after head trauma, but traumatic intracranial hemorrhage (ICH) was rare (1.1%). Routine CT may not be necessary for asymptomatic children with bleeding disorders.

Area of Science:

  • Pediatric Emergency Medicine
  • Neurotrauma
  • Hematology

Background:

  • Blunt head trauma in children necessitates careful evaluation for traumatic intracranial hemorrhage (ICH).
  • Children with congenital and acquired bleeding disorders may be at increased risk for ICH, influencing diagnostic decisions.

Purpose of the Study:

  • To compare computerized tomography (CT) utilization and the prevalence of traumatic intracranial hemorrhage (ICH) in pediatric patients with and without bleeding disorders following blunt head trauma.

Main Methods:

  • A multicenter cohort study included 43,904 children under 18 years old with blunt head trauma evaluated in 25 emergency departments.
  • CT use and ICH prevalence were compared between children with (n=230) and without bleeding disorders, controlling for Glasgow Coma Scale (GCS) scores.

Main Results:

  • Children with bleeding disorders had significantly higher CT rates (Risk Ratio 2.29) compared to those without bleeding disorders, even with similar GCS scores (14-15).
  • ICH prevalence was low in both groups: 1.1% in children with bleeding disorders versus 4.4% in children without bleeding disorders.
  • No children with bleeding disorders and ICH required neurosurgery, and all presented with symptoms.

Conclusions:

  • Despite increased CT utilization in children with bleeding disorders, traumatic intracranial hemorrhage is uncommon (1.1%) and associated with symptoms.
  • Routine CT imaging may not be indicated for asymptomatic children with congenital or acquired bleeding disorders presenting after head trauma.
Abstract

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