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Ambulatory or inpatient management of mild TBI in children: a post-concussion analysis
Danielle S Wendling-Keim1, Adriana König2, Hans-Georg Dietz2
1Pediatric Surgery, Dr. von Hauner Children's Hospital, Ludwig Maximilian University of Munich, Lindwurmstr. 4, 80337, Munich, Germany. Danielle.Wendling@med.uni-muenchen.de.
Insights
The PECARN rules effectively guide the management of children with mild traumatic brain injury (mTBI), ensuring safe decisions for ambulatory or inpatient care. This approach leads to high patient satisfaction and minimal post-concussion syndrome incidence.
Area of Science:
- Pediatric Emergency Medicine
- Neurology
- Trauma Care
Background:
- Diagnosing and treating mild traumatic brain injury (mTBI) in children is challenging due to subtle initial symptoms.
- Standardized guidelines are crucial for imaging decisions and determining inpatient versus ambulatory care for pediatric mTBI.
- The study aimed to validate the PECARN rules for identifying clinically significant brain injuries in children, ensuring low complication rates and high patient satisfaction.
Purpose of the Study:
- To evaluate the efficacy of PECARN rules in managing pediatric mild traumatic brain injury (mTBI).
- To assess the safety and effectiveness of PECARN-guided decision-making for ambulatory versus inpatient treatment.
- To determine complication rates, patient satisfaction, and post-concussion syndrome incidence following PECARN rule application.
Main Methods:
- A cohort of 478 children with mTBI was enrolled, with 267 valid family questionnaires analyzed.
- Patient records and questionnaires were reviewed to categorize patients into ambulatory (140) and hospitalized (127) groups.
- The study analyzed imaging results, treatment pathways, follow-up needs, and post-concussion syndrome development.
Main Results:
- Among ambulatory mTBI patients, only 9% underwent imaging, with no pathological findings.
- In hospitalized patients, 32.2% had imaging, revealing pathological findings in only 2.4% (skull fracture or intracranial hemorrhage).
- A high patient satisfaction rate was observed in both groups, with only 3.7% developing post-concussion syndrome and most not requiring follow-up.
Conclusions:
- The study confirms the safety and effectiveness of PECARN rules in clinical practice for pediatric mTBI management.
- PECARN rule application facilitates appropriate decisions for ambulatory or inpatient care, minimizing unnecessary interventions.
- The findings support the use of PECARN rules to ensure safe and satisfactory outcomes for children with mild traumatic brain injury.
Background:
Diagnosis and treatment of children with mild traumatic brain injury (mTBI) remain a challenge since initial signs and symptoms do not always indicate the severity of the trauma. Therefore, guidelines regarding the decision upon imaging methods and ambulatory or hospitalized treatment are needed. The goal of our study was to investigate if the standard that was allied from the PECARN rules and is applied in this study can ensure that patients with clinically important brain injury are recognized and leads to outcomes with a low complication rate, a high patient satisfaction and minimal post-concussion syndrome incidence.
Methods:
We enrolled 478 children with mTBI and contacted their families with a questionnaire. Out of these, 267 valid questionnaires were received. Patient records and questionnaires were analyzed yielding a number of 140 ambulatory and 127 hospitalized patients.
Results:
Patients with mild TBI were admitted according to the above-mentioned guidelines or sent home for observation through their parents after thorough patient examination and information. Among ambulatory patients only 13 children (9%) underwent any imaging procedure; however, none of those showed any pathological findings. Next, in 41 of 127 hospitalized patients (32.2%) an imaging study was performed and of these only 3 according to 2.4% of hospitalized patients showed pathological findings, namely a skull fracture, two of them in combination with an intracranial hemorrhage. The duration of inpatient observation was 48 h in most cases (55.3%). Moreover, a majority of all patients (72.4%) did not seek any follow-up visit and did not need any further treatment. Of all patients in the study, only 10 patients according to 3.7% developed a post-concussion syndrome. Patient satisfaction was very high in both, the ambulatory and hospitalized patient group.
Conclusion:
This study confirms that PECARN rules as administered in this study can ensure safe decision-making regarding ambulatory or inpatient treatment.
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