Related Experiment Video
Updated: Apr 17, 2026
Development of an Uncomplicated Mild Traumatic Brain Injury Model Modified by Weight-Drop Method and Evidenced by Magnetic Resonance Imaging
Published on: April 11, 2025
[Mild traumatic brain injury in children: can we predict intracranial complications?]
Iris S Tilma1, Jolita Bekhof, Paul L P Brand
1Isala, Amalia kindercentrum, Zwolle.
Insights
In children with mild traumatic brain injury, common clinical signs and symptoms do not reliably predict intracranial bleeding. A watchful approach without immediate imaging is often safe for mild cases.
Area of Science:
- Pediatric Emergency Medicine
- Neurotrauma
- Radiology
Background:
- Mild traumatic brain injury (mTBI) is common in children.
- Intracranial bleeding (ICB) is a potential complication, but its prediction based on clinical presentation is challenging.
- Current guidelines often recommend imaging, raising concerns about radiation exposure.
Purpose of the Study:
- To evaluate the predictive value of various clinical signs and symptoms for identifying intracranial bleeding (ICB) in pediatric patients with mild traumatic brain injury (mTBI).
- To determine if a 'wait-and-see' approach is safe and justified in this patient population.
Main Methods:
- Retrospective chart review of 410 children (0-18 years) with mTBI presenting to a regional trauma center.
- Analysis of clinical data including vomiting, drowsiness, headache, and neurological symptoms.
- Calculation of sensitivity, specificity, odds ratio, and likelihood ratio for predicting ICB.
Main Results:
- Intracranial bleeding (ICB) was detected in 2.4% of patients, with only one requiring neurosurgery.
- None of the assessed clinical signs or symptoms demonstrated a statistically significant association with ICB or skull fractures.
- A significant proportion of children underwent CT scans (20.5%) or clinical observation (68.8%).
Conclusions:
- Clinical signs and symptoms are not reliable predictors of intracranial bleeding (ICB) in children with mild traumatic brain injury (mTBI).
- Given the low incidence of ICB and risks of radiation from CT scans, a strategy of initial observation without immediate imaging is considered safe and justified for children with mTBI who lack serious neurological symptoms.
Objective:
To investigate whether clinical signs and symptoms can predict intracranial bleeding (ICB) in children with mild traumatic brain injury.
Design:
Retrospective chart review.
Method:
We analysed clinical records from all children (0-18 years) who presented at the Emergency Department or were admitted to the paediatric ward of Isala, a regional trauma centre in Zwolle, the Netherlands, with mild traumatic brain injury between 2011 and 2013. We investigated the predictive value of vomiting, drowsiness, headache, periorbital haematoma, change in behaviour, seizures, amnesia, loss of consciousness and mild neurological symptoms for the presence of ICB by calculating sensitivity, specificity, odds ratio and likelihood ratio.
Results:
We analysed data from 410 patients (248 boys; mean [SD] age 4.5 [5.1] years). Most (n = 381, 93%) had normal consciousness on presentation. A CT scan was performed on admission in 84 patients (20.5%); 282 children (68.8%) were admitted for clinical observation (with or without head CT scan) and 51 children (12.4%) were discharged home immediately without imaging or observation. We found ICB in 10 patients (2.4%), only one of whom required neurosurgical intervention. None of the investigated clinical signs and symptoms showed a statistically significant association with bleeding or skull fractures on head CT scan.
Conclusion:
In this study, no clinical sign or symptom could predict the risk of ICB in children with mild traumatic brain injury. Taking the low likelihood of ICB and the radiation damage associated with CT scanning into account, we conclude that a wait-and-see approach without initial imaging is justified and safe in children with mild traumatic brain injury without serious neurological symptoms.
