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A Novel Model of Mild Traumatic Brain Injury for Juvenile Rats
Published on: December 8, 2014
Low Risk of Clinically Important Traumatic Brain Injury in Children Who Tumble Down Stairs
Donna C Koo1, Jennifer Xie1, Mitchell R Price2
1Department of Surgery at Zucker School of Medicine, Manhasset, NY, USA; Northwell, New Hyde Park, NY, USA.
Insights
Tumbling down stairs in children rarely causes clinically important traumatic brain injuries (ciTBI). Current risk assessment tools, like PECARN, may overestimate risk for these falls, suggesting a need for revised guidelines.
Area of Science:
- Pediatric Emergency Medicine
- Neurotrauma Research
- Clinical Risk Stratification
Background:
- Pediatric trauma management aims to reduce unnecessary head CT scans while identifying critical head injuries.
- The PECARN system categorizes pediatric head injury risk but is often misapplied to falls down stairs (TDS).
- TDS is frequently assessed using free-fall criteria, despite evidence suggesting lower injury risk.
Purpose of the Study:
- To evaluate the incidence of clinically important traumatic brain injuries (ciTBI) in pediatric patients following tumbling down stairs (TDS).
- To model the risk stratification of pediatric TDS patients using modified PECARN criteria based on step height.
- To determine if TDS should be considered a severe mechanism requiring the same risk assessment as free falls.
Main Methods:
- A retrospective chart review of 344 pediatric patients who experienced TDS.
- Development of three PECARN-based risk stratification models: TDS-12 (12-inch steps), TDS-8 (8-inch steps), and TDS-0 (TDS not a severe mechanism).
- Analysis of injury mechanism, clinical presentation, imaging, and ciTBI incidence.
Main Results:
- No patients in the study (0%) sustained a ciTBI, including 88 who fell 12 or more steps.
- The TDS-0 model significantly reduced the number of patients classified as high- or intermediate-risk (6.7%) compared to TDS-12 (97.7%) and TDS-8 (98.1%).
- Under the TDS-8 model, 34% of patients shifted to the low-risk category, and under TDS-0, 79% shifted to low-risk.
Conclusions:
- The risk of ciTBI in pediatric patients following TDS is low.
- Current application of PECARN criteria designed for free falls may lead to over-triage in pediatric TDS cases.
- TDS should be re-evaluated as a distinct mechanism in pediatric head injury risk assessment, separate from free falls.
Background:
Pediatric trauma management seeks to minimize head computed tomography (HCT) while capturing clinically important traumatic brain injuries (ciTBI). The Pediatric Emergency Care Applied Research Network (PECARN) system stratifies patients as high-, intermediate-, or low-risk for ciTBI. Although designed for free falls, we noted that PECARN criteria often are applied to tumbling down stairs (TDS), with steps estimated at 12", though TDS rarely appeared to result in ciTBI.
Methods:
In a retrospective chart review of pediatric TDS patients, data was collected on mechanism of injury, clinical presentation, imaging, and incidence of ciTBI. PECARN scores were developed under three models: TDS-12 (12″ steps), TDS-8 (more accurate 8" steps), and TDS-0 (TDS not a severe mechanism).
Results:
344 patients met criteria for study inclusion. Mean age was 6.3 years and 89 (26%) were <2 years. No patients had ciTBI. This included 88 patients who tumbled down 12 steps or more. Across all models, the same 7 patients (2.0%) were at high-risk for ciTBI. Intermediate- and low-risk cohorts were 287 (83%) and 50 (15%) for TDS-12, 171 (50%) and 166 (48%) for TDS-8, and 16 (4.7%) and 321 (93%) for TDS-0, respectively for each model. Under TDS-8, 116 (34%) patients shifted to the low-risk category. Under TDS-0, 271 (79%) patients shifted to the low-risk category, leaving only 23 patients (6.7%) at high- or intermediate-risk (n = 7, 16, respectively).
Conclusions:
In pediatric patients, the risk of ciTBI after TDS is low. TDS should not be treated as a free fall in risk assessment.
Type Of Study:
Retrospective Modeling Study.
Level Of Evidence:
Level III.
