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Risk of traumatic intracranial haemorrhage in children with bleeding disorders
Silvia Bressan1,2, Paul Monagle1,3,4, Stuart R Dalziel5,6
1Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.
Insights
Children with bleeding disorders are more likely to receive a head CT scan after trauma. However, their risk of intracranial hemorrhage (ICH) is low, suggesting selective CT use may be appropriate.
Area of Science:
- Pediatric Emergency Medicine
- Neurology
- Radiology
Background:
- Head trauma is common in children, and bleeding disorders increase the risk of intracranial hemorrhage (ICH).
- Computerised tomography (CT) is frequently used to diagnose ICH, but its overuse in children with bleeding disorders following head trauma is a concern.
Purpose of the Study:
- To evaluate the utilization of CT scans in children with bleeding disorders who experience head trauma.
- To determine the incidence of ICH in this patient population.
Main Methods:
- A multicentre prospective observational study was conducted across 10 Australian and New Zealand paediatric emergency departments.
- Data on patient characteristics, management, and outcomes were collected for children under 18 years with and without bleeding disorders following head trauma between April 2011 and November 2014.
Main Results:
- Out of 20,137 patients, 103 (0.5%) had a bleeding disorder. CT use was significantly higher in children with bleeding disorders (30.1%) compared to those without (10.4%).
- Only one child (3.2%) who underwent CT in the emergency department (ED) had an ICH, and this patient required neurosurgery due to rapid deterioration.
- No ICH was found in bleeding disorder patients who did not have an ED CT or had an initial negative CT upon follow-up.
Conclusions:
- Children with bleeding disorders and head trauma undergo CT scans more frequently, but their risk of ICH appears low and is linked to clinical findings.
- Selective CT use, guided by clinical presentation and bleeding disorder severity, combined with observation, may be a safe approach for these children.
Aim:
To assess computerised tomography (CT) use and the risk of intracranial haemorrhage (ICH) in children with bleeding disorders following a head trauma.
Methods:
Design: Multicentre prospective observational study.
Setting:
10 paediatric emergency departments (ED) in Australia and New Zealand.
Patients:
Children <18 years with and without bleeding disorders assessed in ED following head trauma between April 2011 and November 2014.
Interventions:
Data collection of patient characteristics, management and outcomes.
Main Outcome Measures:
Rate of CT use and frequency of ICH on CT.
Results:
Of 20 137 patients overall, 103 (0.5%) had a congenital or acquired bleeding disorder. CT use was higher in these patients compared with children without bleeding disorders (30.1 vs. 10.4%; rate ratio 2.91 95% CI 2.16-3.91). Only one of 31 (3.2%) children who underwent CT in the ED had an ICH. This patient rapidly deteriorated in the ED on arrival and required neurosurgery. None of the patients with bleeding disorders who did not have a CT obtained in the ED or had an initial negative CT had evidence of ICH on follow up.
Conclusions:
Although children with a bleeding disorder and a head trauma more often received a CT scan in the ED, their risk of ICH seemed low and appeared associated with post-traumatic clinical findings. Selective CT use combined with observation may be cautiously considered in these children based on clinical presentation and severity of bleeding disorder.
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