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Presenting characteristics of children who required neurosurgical intervention for head injury
Oren Tavor1, Sirisha Boddu2, Abhaya V Kulkarni3
1Pediatric Emergency Department, Dana Children Hospital, Tel Aviv Soraski Medical Center, 6 Weizmann St., Tel Aviv, Israel. tavororen@gmail.com.
Insights
Children needing neurosurgery after head injury almost always meet imaging criteria from major clinical decision rules. Severe mechanism of injury was the most common reason for CT scans in these pediatric head trauma cases.
Area of Science:
- Pediatric neurosurgery
- Trauma care
- Clinical decision rules
Background:
- Head injuries in children necessitate careful evaluation to determine the need for neurosurgical intervention (NSI).
- Clinical decision rules (CDRs) like CHALICE, PECARN, and CATCH aid in deciding whether imaging is required.
- Assessing the performance of these CDRs in children who ultimately require NSI is crucial for refining diagnostic pathways.
Purpose of the Study:
- To characterize children requiring neurosurgical intervention (NSI) after head trauma.
- To evaluate how well existing clinical decision rules (CHALICE, PECARN, CATCH) identify these children.
Main Methods:
- Retrospective review of 182 children who underwent NSI following head injury (2000-2008).
- Exclusion of non-accidental injuries, penetrating trauma, and incomplete data.
- Application of CHALICE, PECARN, and CATCH imaging criteria to patients with mild head injury (GCS 14-15).
Main Results:
- Out of 182 patients, 72 had mild head injury; 98.6% met at least one imaging criterion from each CDR.
- Common indications included severe mechanism of injury (94.4%), skull fracture (48.6%), and neurological deficit (26.3%).
- Only 0.5% of the total cohort lacked an obvious CT indication across all three CDRs.
Conclusions:
- The majority of children requiring NSI after head trauma meet the imaging criteria of CHALICE, PECARN, and CATCH CDRs.
- Severe mechanism of injury is the most frequent indicator for CT scans in this population.
- These CDRs effectively identify nearly all pediatric patients who need neurosurgical intervention for head injuries.
Purpose:
The purpose of this study is to describe the presenting characteristics of a large group of children who required neurosurgical intervention (NSI) following a head injury and to retrospectively assess which of the criteria for imaging from Children's Head Injury Algorithm for the Prediction of Important Clinical Events (CHALICE), Pediatric Emergency Care Applied Research Network (PECARN), and Canadian Assessment of Tomography for Childhood Head Injury (CATCH) clinical decision rules (CDRs) were met by these patients.
Study Design:
We retrospectively reviewed all patients undergoing NSI following a head injury, between 2000 and 2008, at a large tertiary pediatric trauma center. We excluded patients having non-accidental injury, other neurosurgical interventions, penetrating injuries, and patients with incomplete data. To those who presented initially with mild head injury (GCS 14-15), we retrospectively applied the criteria for imaging of the CHALICE, PECARN, and CATCH CDRs.
Results:
Out of 289 patients undergoing NSI, 182 met inclusion criteria and comprised our cohort. Of the 72 (39.6 %) with mild head injury (GCS 14-15), 71 (98.6 %) met at least one criteria for imaging from each of the three CDRs, including severe mechanism of injury (68, 94.4 %), clinically evident skull fracture (35, 48.6 %), neurological deficit (19, 26.3 %), or severe headache (6, 8.3 %). Of the 182 patients in the entire cohort, only 1 (0.5 %) did not present with an obvious indication for CT on all three CDRs.
Conclusions:
In a large sample of children requiring NSI after head trauma, the vast majority met CT criteria listed in each of the three CDRs. The most common indication for CT was a severe mechanism of injury. This, combined with clinically evident skull fracture, neurological deficit, and severe headache, identifies almost all patients requiring NSI.
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