Traumatic brain injuries and computed tomography use in pediatric sports participants
Todd Glass1, Richard M Ruddy2, Elizabeth R Alpern3
1Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati Ohio, and Department of Pediatrics, Nemours Children's Hospital, Orlando, FL.
Insights
Pediatric sports-related head trauma often leads to CT scans, but only 4% show injuries. Clinically important traumatic brain injuries (ciTBIs) are rare (1%), varying by sport, highlighting prevention needs.
Area of Science:
- Pediatric Emergency Medicine
- Neurotrauma
- Sports Medicine
Background:
- Childhood sports-related head trauma is a frequent cause of emergency department (ED) visits.
- Computed tomography (CT) use for evaluating these injuries is common.
Purpose of the Study:
- To describe the spectrum of sports-related head injuries in children.
- To analyze trends in CT utilization and traumatic brain injury (TBI) detection.
- To identify sports with higher risks for clinically important TBIs (ciTBIs).
Main Methods:
- Secondary analysis of a prospective cohort of 23,082 children with head trauma (2004-2006).
- Compared children aged 5-18 by CT rate, TBI on CT, and ciTBI.
- Used multivariable logistic regression to adjust CT rates for clinical severity.
Main Results:
- Sports-related head trauma occurred in 14% of children.
- 53% of these children received an ED CT scan.
- 4% of CT scans revealed TBIs, and 1% indicated ciTBIs.
- Equestrian sports showed higher CT odds; snow and nonmotorized wheeled sports had increased ciTBI odds.
Conclusions:
- CT scans are frequently used for pediatric sports-related head trauma, though TBIs are found in only 4% of those imaged.
- Clinically important TBIs are infrequent (1%) but vary significantly by sport.
- Opportunities exist for targeted injury prevention in high-risk sports and reducing unnecessary CT use.
Background:
Childhood sports-related head trauma is common, frequently leading to emergency department (ED) visits. We describe the spectrum of these injuries and trends in computed tomography (CT) use in the Pediatric Emergency Care Applied Research Network.
Methods:
This was a secondary analysis of a large prospective cohort of children with head trauma in 25 Pediatric Emergency Care Applied Research Network EDs between 2004 and 2006. We described and compared children 5 to 18 years old by CT rate, traumatic brain injury (TBI) on CT, and clinically important TBI (ciTBI). We used multi-variable logistic regression to compare CT rates, adjusting for clinical severity. Outcomes included frequency of CT, TBIs on CT, and ciTBIs (defined by [a] death, [b] neurosurgery, [c] intubation>24 hours, or [d] hospitalization for ≥2 nights).
Findings:
A total of 3289 (14%) of 23082 children had sports-related head trauma. Two percent had Glasgow Coma Scale scores less than 14. 53% received ED CTs, 4% had TBIs on CT, and 1% had ciTBIs. Equestrians had increased adjusted odds (1.8; 95% confidence interval [CI], 1.0-3.0]) of CTs; the rate of TBI on CT was 4% (95% CI, 3%-5%). Compared with team sports, snow (adjusted odds ratio, 4.1; 95% CI 1.5-11.4) and nonmotorized wheeled (adjusted odds ratio, 12.8; 95% CI, 5.5-32.4) sports had increased adjusted odds of ciTBIs.
Conclusions:
Children with sports-related head trauma commonly undergo CT. Only 4% of those imaged had TBIs on CT. Clinically important TBIs occurred in 1%, with significant variation by sport. There is an opportunity for injury prevention efforts in high-risk sports and opportunities to reduce CT use in general by use of evidence-based prediction rules. What is known about this subject: Pediatric sports-related head injuries are a common and increasingly frequent ED presentation, as is the use of CT in their evaluation. Little is known about TBIs resulting from different types of sports activities in children. What this study adds to existing knowledge: This study broadens the understanding of the epidemiology of Pediatric TBIs resulting from different sports activities through a prospective assessment of frequency and severity of ciTBIs and ED CT use in a large cohort of head-injured children in a network of pediatric EDs.
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