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Utility and Predictive Value of CHIIDA Score in Pediatric Traumatic Brain Injury: A Prospective Observational Study
Ruchi A Jain1, Hemangi S Karnik, Deepti M Kotwani
1Department of Anesthesia, Lokmanya Tilak Municipal Medical College and General Hospital, Sion, Mumbai, Maharshtra, India.
Insights
The Children's Intracranial Injury Decision Aid (CHIIDA) is not a reliable tool for determining which pediatric patients with mild traumatic brain injury (mTBI) do not need intensive care unit (ICU) admission. Further research is needed to improve mTBI triage in children.
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.
Background:
The Children's Intracranial Injury Decision Aid (CHIIDA) is a tool designed to stratify children with mild traumatic brain injury (mTBI). The aim of this study was to assess the utility and predictive value of CHIIDA in the assessment of the need for intensive care unit (ICU) admission in pediatric patients with mTBI.
Methods:
This prospective observational study included 425 children below 18 years of age admitted to the ICU of a tertiary care hospital with mTBI (Glasgow Coma Scale 13 to 15). The primary outcome was the composite of neurosurgical intervention, intubation for more than 24 hours for TBI, or death from TBI. Sensitivity, specificity, predictive values and likelihood ratios were calculated at CHIIDA scores 0 and 2.
Results:
Among 425 children with mTBI, 210 (49%) had a CHIIDA score 0, 16 (4%) scored 2 points, and 199 (47%) scored more than 2 points. Thirty-six (8.47%) patients experienced the primary outcome, and there were 3 deaths. A cutoff CHIIDA >0 to admit to ICU had a sensitivity of 97.22% (95% confidence interval [CI], 97.05%-97.39%) and a negative predictive value of 99.54% (95% CI, 99.50%-99.56%). A cutoff of score >2 had a sensitivity of 97.22% (95% CI, 97.05%-97.39%), and negative predictive value of 99.56% (95% CI, 99.54%-99.59%). The post-test probability at cutoff score of 0 and 2 was 16.65% and 16.27%, respectively.
Conclusions:
CHIIDA score does not serve as reliable triage tool for identifying children with TBI who do not require ICU admission.
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