Mild traumatic brain injury in children with ventricular shunts: a PREDICT study.

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  • Additional Information
    • Corporate Authors:
      MBiostat; 2Murdoch Children's Research Institute, Melbourne, Victoria, Australia.
    • Source:
      Publisher: American Association of Neurological Surgeons Country of Publication: United States NLM ID: 101463759 Publication Model: Electronic-Print Cited Medium: Internet ISSN: 1933-0715 (Electronic) Linking ISSN: 19330707 NLM ISO Abbreviation: J Neurosurg Pediatr Subsets: MEDLINE
    • Publication Information:
      Original Publication: Charlottesville, VA : American Association of Neurological Surgeons, 2004-
    • Subject Terms:
      Ventriculoperitoneal Shunt*; Brain Concussion/*surgery ; Clinical Decision-Making/*methods ; Neurosurgical Procedures/*methods; Adolescent ; Algorithms ; Australia ; Brain Concussion/complications ; Brain Concussion/diagnostic imaging ; Child ; Child, Preschool ; Cohort Studies ; Female ; Glasgow Coma Scale ; Humans ; Hydrocephalus/etiology ; Hydrocephalus/surgery ; Infant ; Male ; New Zealand ; Prospective Studies ; Tomography, X-Ray Computed ; Treatment Outcome
    • Abstract:
      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.
    • Contributed Indexing:
      Keywords: child; hydrocephalus; trauma; traumatic brain injury; ventricular shunt
    • Publication Date:
      Date Created: 20201130 Date Completed: 20220224 Latest Revision: 20240813
    • Publication Date:
      20240813
    • Accession Number:
      10.3171/2020.7.PEDS2090
    • Accession Number:
      33254139