External validation of the Scandinavian guidelines for management of minimal, mild and moderate head injuries in children.

Item request has been placed! ×
Item request cannot be made. ×
loading   Processing Request
Read Online Read More Add to Saved list
  • Additional Information
    • Corporate Authors:
      Paediatric Research in Emergency Departments International Collaborative (PREDICT)
    • Source:
      Publisher: BioMed Central Country of Publication: England NLM ID: 101190723 Publication Model: Electronic Cited Medium: Internet ISSN: 1741-7015 (Electronic) Linking ISSN: 17417015 NLM ISO Abbreviation: BMC Med Subsets: MEDLINE
    • Publication Information:
      Original Publication: [London] : BioMed Central, 2003-
    • Subject Terms:
      Decision Support Techniques* ; Practice Guidelines as Topic*; Brain Injuries, Traumatic/*diagnosis ; Brain Injuries, Traumatic/*therapy; Adolescent ; Australia ; Child ; Child, Preschool ; Cohort Studies ; Female ; Humans ; Infant ; Male ; New Zealand ; Prospective Studies
    • Abstract:
      Background: Clinical decision rules (CDRs) aid in the management of children with traumatic brain injury (TBI). Recently, the Scandinavian Neurotrauma Committee (SNC) has published practical, evidence-based guidelines for children with Glasgow Coma Scale (GCS) scores of 9-15. This study aims to validate these guidelines and to compare them with other CDRs.
      Methods: A large prospective cohort of children (< 18 years) with TBI of all severities, from ten Australian and New Zealand hospitals, was used to assess the SNC guidelines. Firstly, a validation study was performed according to the inclusion and exclusion criteria of the SNC guideline. Secondly, we compared the accuracy of SNC, CATCH, CHALICE and PECARN CDRs in patients with GCS 13-15 only. Diagnostic accuracy was calculated for outcome measures of need for neurosurgery, clinically important TBI (ciTBI) and brain injury on CT.
      Results: The SNC guideline could be applied to 19,007/20,137 of patients (94.4%) in the validation process. The frequency of ciTBI decreased significantly with stratification by decreasing risk according to the SNC guideline. Sensitivities for the detection of neurosurgery, ciTBI and brain injury on CT were 100.0% (95% CI 89.1-100.0; 32/32), 97.8% (94.5-99.4; 179/183) and 95% (95% CI 91.6-97.2; 262/276), respectively, with a CT/admission rate of 42% (mandatory CT rate of 5%, 18% CT or admission and 19% only admission). Four patients with ciTBI were missed; none needed specific intervention. In the homogenous comparison cohort of 18,913 children, the SNC guideline performed similar to the PECARN CDR, when compared with the other CDRs.
      Conclusion: The SNC guideline showed a high accuracy in a large external validation cohort and compares well with published CDRs for the management of paediatric TBI.
    • References:
      BMJ. 2013 May 21;346:f2360. (PMID: 23694687)
      Ann Emerg Med. 2007 Apr;49(4):403-7, 407.e1. (PMID: 17141146)
      Arch Dis Child. 2006 Nov;91(11):885-91. (PMID: 17056862)
      BMC Pediatr. 2014 Jun 13;14:148. (PMID: 24927811)
      N Engl J Med. 2007 Nov 29;357(22):2277-84. (PMID: 18046031)
      Ann Emerg Med. 2004 Feb;43(2):215-23. (PMID: 14747811)
      Lancet Neurol. 2017 Dec;16(12):987-1048. (PMID: 29122524)
      BMC Neurol. 2016 Oct 20;16(1):200. (PMID: 27765016)
      Prehosp Disaster Med. 2015 Feb;30(1):46-53. (PMID: 25489727)
      Radiology. 2009 Apr;251(1):175-84. (PMID: 19332852)
      Clin Chem. 2012 Jul;58(7):1116-22. (PMID: 22529109)
      J Am Med Inform Assoc. 2014 Oct;21(e2):e347-51. (PMID: 24534635)
      NeuroRehabilitation. 2007;22(5):341-53. (PMID: 18162698)
      Lancet Neurol. 2008 Aug;7(8):728-41. (PMID: 18635021)
      J Trauma. 2000 Apr;48(4):760-6. (PMID: 10780615)
      BMC Med. 2013 Feb 25;11:50. (PMID: 23432764)
      Brain Inj. 2008 Feb;22(2):175-81. (PMID: 18240046)
      CMAJ. 2010 Mar 9;182(4):341-8. (PMID: 20142371)
      Acad Emerg Med. 2007 Nov;14(11):955-9. (PMID: 17923717)
      JAMA Pediatr. 2013 Aug 1;167(8):700-7. (PMID: 23754213)
      Pediatrics. 2015 Jul;136(1):e227-33. (PMID: 26101363)
      Acta Neurol Scand. 2006 Apr;113(4):262-6. (PMID: 16542166)
      Lancet. 2012 Aug 4;380(9840):499-505. (PMID: 22681860)
      Ann Emerg Med. 2018 Jun;71(6):703-710. (PMID: 29452747)
      Lancet Neurol. 2018 Sep;17(9):782-789. (PMID: 30054151)
      Lancet. 2009 Oct 3;374(9696):1160-70. (PMID: 19758692)
      Radiology. 2011 Jun;259(3):793-801. (PMID: 21467249)
      Emerg Med Australas. 2006 Apr;18(2):143-7. (PMID: 16669940)
      Acad Emerg Med. 2012 Jul;19(7):801-7. (PMID: 22724450)
      BMJ. 2006 Sep 2;333(7566):465. (PMID: 16895944)
      Acta Neurochir (Wien). 2015 Oct;157(10):1683-96. (PMID: 26269030)
      BMC Med. 2016 Feb 18;14:33. (PMID: 26888597)
      Emerg Med J. 2013 Oct;30(10):790-4. (PMID: 23015114)
      Lancet. 2017 Jun 17;389(10087):2393-2402. (PMID: 28410792)
    • Contributed Indexing:
      Keywords: Child; Clinical decision rule; Computed tomography; Guideline; Head injury; Head trauma; Infant; Scandinavia
    • Publication Date:
      Date Created: 20181013 Date Completed: 20190114 Latest Revision: 20191210
    • Publication Date:
      20221213
    • Accession Number:
      PMC6182797
    • Accession Number:
      10.1186/s12916-018-1166-8
    • Accession Number:
      30309392