Please use this identifier to cite or link to this item:
https://hdl.handle.net/2440/121037
Citations | ||
Scopus | Web of Science® | Altmetric |
---|---|---|
?
|
?
|
Type: | Journal article |
Title: | Delayed presentations to emergency departments of children with head injury: a PREDICT study |
Author: | Borland, M.L. Dalziel, S.R. Phillips, N. Lyttle, M.D. Bressan, S. Oakley, E. Hearps, S.J.C. Kochar, A. Furyk, J. Cheek, J.A. Neutze, J. Gilhotra, Y. Dalton, S. Babl, F.E. |
Citation: | Annals of Emergency Medicine, 2019; 74(1):1-10 |
Publisher: | Elsevier |
Issue Date: | 2019 |
ISSN: | 0196-0644 1097-6760 |
Statement of Responsibility: | Meredith L. Borland, Stuart R. Dalziel, Natalie Phillips, Mark D. Lyttle, Silvia Bressan ... Amit Kocha ... et al. |
Abstract: | STUDY OBJECTIVE:Existing clinical decision rules guide management for head-injured children presenting 24 hours or sooner after injury, even though some may present greater than 24 hours afterward. We seek to determine the prevalence of traumatic brain injuries for patients presenting to emergency departments greater than 24 hours after injury and identify symptoms and signs to guide management. METHODS:This was a planned secondary analysis of the Australasian Paediatric Head Injury Rule Study, concentrating on first presentations greater than 24 hours after injury, with Glasgow Coma Scale scores 14 and 15. We sought associations with predictors of traumatic brain injury on computed tomography (CT) and clinically important traumatic brain injury. RESULTS:Of 19,765 eligible children, 981 (5.0%) presented greater than 24 hours after injury, and 465 injuries (48.5%) resulted from falls less than 1 m and 37 (3.8%) involved traffic incidents. Features associated significantly with presenting greater than 24 hours after injury in comparison with presenting within 24 hours were nonfrontal scalp hematoma (20.8% versus 18.1%), headache (31.6% versus 19.9%), vomiting (30.0% versus 16.3%), and assault with nonaccidental injury concerns (1.4% versus 0.4%). Traumatic brain injury on CT occurred in 37 patients (3.8%), including suspicion of depressed skull fracture (8 [0.8%]) and intracranial hemorrhage (31 [3.8%]). Clinically important traumatic brain injury occurred in 8 patients (0.8%), with 2 (0.2%) requiring neurosurgery, with no deaths. Suspicion of depressed skull fracture was associated with traumatic brain injury on CT consistently, with the only other significant factor being nonfrontal scalp hematoma (odds ratio 19.0; 95% confidence interval 8.2 to 43.9). Clinically important traumatic brain injury was also associated with nonfrontal scalp hematoma (odds ratio 11.7; 95% confidence interval 2.4 to 58.6) and suspicion of depressed fracture (odds ratio 19.7; 95% confidence interval 2.1 to 182.1). CONCLUSION:Delayed presentation after head injury, although infrequent, is significantly associated with traumatic brain injury. Evaluation of delayed presentations must consider identified factors associated with this increased risk. |
Keywords: | Paediatric Research in Emergency Department International Collaborative (PREDICT) Group Scalp Humans Intracranial Hemorrhages Headache Skull Fracture, Depressed Hematoma Vomiting Tomography, X-Ray Computed Glasgow Coma Scale Prevalence Adolescent Child Child, Preschool Infant Emergency Service, Hospital Australasia Female Male Time-to-Treatment Clinical Decision-Making Brain Injuries, Traumatic |
Rights: | © 2018 by the American College of Emergency Physicians. |
DOI: | 10.1016/j.annemergmed.2018.11.035 |
Grant ID: | http://purl.org/au-research/grants/nhmrc/1046727 http://purl.org/au-research/grants/nhmrc/1058560 |
Published version: | http://dx.doi.org/10.1016/j.annemergmed.2018.11.035 |
Appears in Collections: | Aurora harvest 4 Medicine publications |
Files in This Item:
There are no files associated with this item.
Items in DSpace are protected by copyright, with all rights reserved, unless otherwise indicated.