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Mild traumatic brain injury in children with ventricular shunts: a PREDICT study
Franz E Babl1,2,3, Mark D Lyttle2,4,5, Natalie Phillips6
11Emergency Department, Royal Children's Hospital, Melbourne.
Insights
Children with ventricular shunts (VSs) have a similar risk of traumatic brain injury (TBI) on CT scans and clinically important TBI (ciTBI) compared to those without VSs. This suggests current clinical decision rules for pediatric TBI may not need exclusion criteria for VSs.
Area of Science:
- Pediatric Traumatic Brain Injury
- Neurosurgery
- Radiology
Background:
- Clinical decision rules (CDRs) for pediatric traumatic brain injury (TBI) often exclude children with ventricular shunts (VSs).
- Limited data exists on the risk of CT scan abnormalities or clinically important TBI (ciTBI) in this specific pediatric population.
- The study addresses the knowledge gap regarding TBI assessment in children with VSs.
Purpose of the Study:
- To determine the frequency of CT scan abnormalities and ciTBI in children with VSs presenting with TBI.
- To assess the presence of CDR predictor variables in pediatric TBI patients with VSs.
- To evaluate the safety and efficacy of current TBI diagnostic pathways in children with VSs.
Main Methods:
- A secondary analysis of a prospective external validation study of three CDRs for TBI in children.
- Inclusion of children with VSs from 10 emergency departments in Australia and New Zealand.
- Comparison of presenting features, management, and acute outcomes (TBI on CT, ciTBI) between children with and without VSs.
Main Results:
- Out of 20,137 children with TBI, 35 (0.2%) had a VS; most had a Glasgow Coma Scale score of 15.
- Children with VSs underwent CT scanning more frequently (49%) than those without (10%).
- The frequency of ciTBI (2.9% vs 1.4%) and TBI on CT (2.9% vs 2.0%) was similar between groups with and without VSs, with no neurosurgical interventions required.
Conclusions:
- The risk of TBI on CT scans and ciTBI is comparable in children with and without VSs.
- Current data supports that children with VSs do not have an elevated risk of acute TBI.
- Findings suggest that exclusion criteria for VSs in pediatric TBI CDRs may not be necessary.
Objective:
Current clinical decision rules (CDRs) guiding the use of CT scanning in pediatric traumatic brain injury (TBI) assessment generally exclude children with ventricular shunts (VSs). There is limited evidence as to the risk of abnormalities found on CT scans or clinically important TBI (ciTBI) in this population. The authors sought to determine the frequency of these outcomes and the presence of CDR predictor variables in children with VSs.
Methods:
The authors undertook a planned secondary analysis on children with VSs included in a prospective external validation of 3 CDRs for TBI in children presenting to 10 emergency departments in Australia and New Zealand. They analyzed differences in presenting features, management and acute outcomes (TBI on CT and ciTBI) between groups with and without VSs, and assessed the presence of CDR predictors in children with a VS.
Results:
A total of 35 of 20,137 children (0.2%) with TBI had a VS; only 2 had a Glasgow Coma Scale score < 15. Overall, 49% of patients with a VS underwent CT scanning compared with 10% of those without a VS. One patient had a finding of TBI on CT scanning, with positive predictor variables on CDRs. This patient had a ciTBI. No patient required neurosurgery. For children with and without a VS, the frequency of ciTBI was 2.9% (95% CI 0.1%-14.9%) compared with 1.4% (95% CI 1.2%-1.6%) (difference 1.5% [95% CI -4.0% to 7.0%]), and TBI on CT 2.9% (95% CI 0.1%-14.9%) compared with 2.0% (95% CI 1.8%-2.2%) (difference 0.9%, 95% CI -4.6% to 6.4%).
Conclusions:
The authors' data provide further support that the risk of TBI is similar for children with and without a VS.
