Utility and Predictive Value of CHIIDA Score in Pediatric Traumatic Brain Injury: A Prospective Observational Study

Area of Science:

• Pediatric Traumatology
• Clinical Decision Support Systems
• Neurocritical Care

Background:

• Mild traumatic brain injury (mTBI) is common in children.
• Accurate triage is crucial for optimal management of pediatric mTBI.
• The Children's Intracranial Injury Decision Aid (CHIIDA) was developed to stratify pediatric mTBI cases.

Purpose of the Study:

• To evaluate the clinical utility and predictive accuracy of the CHIIDA score.
• To determine if CHIIDA can reliably identify pediatric mTBI patients who do not require intensive care unit (ICU) admission.

Main Methods:

• A prospective observational study of 425 children (<18 years) with mTBI (GCS 13-15) admitted to a tertiary care ICU.
• Primary outcome: composite of neurosurgical intervention, intubation >24h for TBI, or death from TBI.
• Calculated sensitivity, specificity, predictive values, and likelihood ratios for CHIIDA scores of 0 and 2.

Main Results:

• 36 (8.47%) patients experienced the primary outcome; 3 deaths occurred.
• A CHIIDA cutoff >0 had 97.22% sensitivity and 99.54% negative predictive value for ICU admission.
• A CHIIDA cutoff >2 also showed high sensitivity (97.22%) and negative predictive value (99.56%).

Conclusions:

• The CHIIDA score's high negative predictive value suggests it may not reliably exclude the need for ICU admission.
• CHIIDA is not a sufficiently reliable triage tool for identifying pediatric mTBI patients who can safely avoid ICU admission.
• Further refinement of triage tools for pediatric mTBI is warranted.