To Örebro University

Background: Head trauma in children is common, with a low rate of clinically-important traumatic brain injury (ciTBI). CT scan is the reference standard for diagnosis of traumatic brain injury, of which the increasing use is alarming because of the risk of induction of lethal malignancies. Recently, the Scandinavian Neurotrauma Committee (SNC) derived new guidelines for the initial management of minor and moderate head trauma (GCS 9-15) in children. Our aim was to validate the SNC guidelines by assessing the risk of a child being discharged with a ciTBI. A secondary aim was to assess the risk of a child being discharged with a TBI on CT.

Methods: We applied the SNC guidelines to a population consisting of children with mild and moderate head trauma, enrolled in the dataset ‘‘Identification of children at very low risk of clinically-important brain injuries after head trauma: a prospective cohort study’’ (Kuppermanns et al 2009). We calculated the SNC guidelines negative predictive values to assess their ability to distinguish children without ciTBI and traumatic brain injuries on CT scans, for whom CT would be unnecessary.

Results: We enrolled and analysed 43 025 children (mean age 7.0 years, range 0-17, 62.3% males). The prevalence of ciTBI were statistically significant lower in the group of minimal head injury as compared to the mild low-risk head injury group (p<0.001). The rate of ciTBI in the minimal head injury group was 0,15% and the negative predictive value was 99.8% for ciTBI (minimal vs mild-moderate head injury groups). Traumatic finding on CT was detected in 3.1% of the children in the minimal group who underwent a CT examination, which accounts for 0.45% of all children in the minimal head injury group. The negative predictive value was 96.9% for traumatic finding on CT.

Conclusion: It is safe to discharge children with oral and written instructions and, according to the SNC guidelines, minimal head injury. Use of the SNC guidelines will potentially reduce the use of CT.