Multicentre study found no increased risk of clinically important brain injuries when children presented more than
Marco Vajna de Pava1, Gregorio Paolo Milani2,3, Gian Vincenzo Zuccotti4,5
1Paediatric Emergency Department, ASST dei Sette Laghi, Varese, Italy.
Insights
Delayed presentation for minor head trauma in children does not increase the risk of clinically important traumatic brain injuries. Existing neuroimaging decision rules can be applied regardless of presentation time.
Area of Science:
- Pediatric Emergency Medicine
- Neurotrauma
- Clinical Decision Rules
Background:
- Validated clinical decision rules for neuroimaging in children with minor head trauma are lacking for evaluations occurring more than 24 hours after injury.
- This gap necessitates research into the impact of delayed presentation on injury detection.
Purpose of the Study:
- To compare the incidence of clinically important traumatic brain injuries (ciTBI) in children presenting with minor head trauma within versus after 24 hours.
- To determine if delayed presentation affects the risk of ciTBI in pediatric patients.
Main Methods:
- Retrospective analysis of 5981 children (aged 0-17 years) treated for minor head trauma across five Italian pediatric emergency departments (January 2019 - June 2020).
- Patients were categorized based on presentation time: within 24 hours or after 24 hours.
- Logistic regression analysis was used to assess the association between presentation time and ciTBI.
Main Results:
- A total of 5981 children were included, with 243 (4.1%) presenting more than 24 hours after injury.
- Neuroimaging was performed on 448 (7.5%) patients.
- Presentation time (within or after 24 hours) did not significantly impact the rates of clinically important traumatic brain injuries, and logistic regression found no association between delayed presentation and ciTBI.
Conclusions:
- Delayed presentation to a pediatric emergency department following minor head trauma does not alter the risk of clinically important traumatic brain injuries.
- The findings suggest that current neuroimaging decision rules can be applied irrespective of the time elapsed since the injury.
Aim:
Validated clinical decision rules on neuroimaging are not available for children who are evaluated more than 24 h after a minor head trauma. We compared clinically important traumatic brain injuries in children who presented with a minor head trauma within or after 24 h.
Methods:
This was a retrospective analysis of patients aged 0-17 years, who were evaluated for minor head traumas by five paediatric emergency departments in Northern Italy between January 2019 and June 2020. Children with clinically important traumatic brain injuries were divided into those who had presented within and after 24 h.
Results:
The study comprised 5981 children (59.9% boys), with a median age of 2 years, including 243 (4.1%) who had presented more than 24 h after their minor head trauma. Neuroimaging was performed on 448 (7.5%) patients and the time of presentation had no impact on the rates of clinically important traumatic brain injuries. Multiple logistic regression did not show any association between clinically important traumatic brain injuries and late presentation.
Conclusion:
Delayed presentation to a paediatric emergency department after a minor head trauma did not alter the risk of clinically important traumatic brain injuries and the same neuroimaging rules could apply.
