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Presenting characteristics of children who required neurosurgical intervention for head injury

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Abstract

Purpose

The purpose of this study is to describe the presenting characteristics of a large group of children who required neurosurgical intervention (NSI) following a head injury and to retrospectively assess which of the criteria for imaging from Children’s Head Injury Algorithm for the Prediction of Important Clinical Events (CHALICE), Pediatric Emergency Care Applied Research Network (PECARN), and Canadian Assessment of Tomography for Childhood Head Injury (CATCH) clinical decision rules (CDRs) were met by these patients.

Study design

We retrospectively reviewed all patients undergoing NSI following a head injury, between 2000 and 2008, at a large tertiary pediatric trauma center. We excluded patients having non-accidental injury, other neurosurgical interventions, penetrating injuries, and patients with incomplete data. To those who presented initially with mild head injury (GCS 14–15), we retrospectively applied the criteria for imaging of the CHALICE, PECARN, and CATCH CDRs.

Results

Out of 289 patients undergoing NSI, 182 met inclusion criteria and comprised our cohort. Of the 72 (39.6 %) with mild head injury (GCS 14–15), 71 (98.6 %) met at least one criteria for imaging from each of the three CDRs, including severe mechanism of injury (68, 94.4 %), clinically evident skull fracture (35, 48.6 %), neurological deficit (19, 26.3 %), or severe headache (6, 8.3 %). Of the 182 patients in the entire cohort, only 1 (0.5 %) did not present with an obvious indication for CT on all three CDRs.

Conclusions

In a large sample of children requiring NSI after head trauma, the vast majority met CT criteria listed in each of the three CDRs. The most common indication for CT was a severe mechanism of injury. This, combined with clinically evident skull fracture, neurological deficit, and severe headache, identifies almost all patients requiring NSI.

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Abbreviations

GCS:

Glasgow coma scale

CT:

Computed tomography

NSI:

Neurosurgical intervention

LOC:

Loss of consciousness

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Authors and Affiliations

  1. Pediatric Emergency Department, Dana Children Hospital, Tel Aviv Soraski Medical Center, 6 Weizmann St., Tel Aviv, Israel

    Oren Tavor

  2. Apollo Clinic, Whitfield, Bangalore, India

    Sirisha Boddu

  3. Division of Neurosurgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada

    Abhaya V. Kulkarni

Authors
  1. Oren Tavor
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  2. Sirisha Boddu
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  3. Abhaya V. Kulkarni
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Corresponding author

Correspondence to Oren Tavor.

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Funding

No external funding was secured for this study.

Financial disclosure

The authors have no financial relationships relevant to this article to disclose.

Conflict of interest

The authors have no conflicts of interest to disclose.

All three authors participated in this study.

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Tavor, O., Boddu, S. & Kulkarni, A.V. Presenting characteristics of children who required neurosurgical intervention for head injury. Childs Nerv Syst 32, 827–831 (2016). https://doi.org/10.1007/s00381-016-3030-5

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  • DOI: https://doi.org/10.1007/s00381-016-3030-5

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