57 - Prevalence of Clinically Important Traumatic Brain Injuries in Children with Altered Mental Status After Minor Blunt Head Trauma

Poster Number: 57
Publication Number: 57.104

Silvia Bressan, University of Padova, Padova, Veneto, Italy; Rachel J. Heidt, Kaiser Foundation Hospital - Roseville Women's and Children's Services, Sacramento, CA, United States; Caroline Wang, Baylor College of Medicine, Houston, TX, United States; Daniel J. Tancredi, University of California, Davis, School of Medicine, Sacramento, CA, United States; Nathan Kuppermann, University of California, Davis, School of Medicine, Sacramento, CA, United States

Background: Altered mental status (AMS) following minor blunt head trauma is one of six risk factors for clinically important traumatic brain injuries (ciTBI) in the two age-specific Pediatric Emergency Care Applied Research Network (PECARN) prediction rules. The components of AMS include a Glasgow Coma Scale (GCS) score of 14 or other signs of AMS. However, the risk of ciTBI associated with isolated AMS, (i.e. with no other PECARN ciTBI predictors), is unknown.

Objective: To assess the risk of ciTBI and TBI on computed tomography (CT) in children with isolated AMS (i.e. with no other PECARN ciTBI predictors).

Design/Methods: Secondary analysis of a large, prospective, multicenter cohort study including 42,412 children < 18 years old with GCS scores of 14 or 15 following blunt head trauma. The study was conducted between June 2004 and September 2006 in 25 PECARN emergency departments. Clinician assessment of AMS was defined by a GCS score of 14 and/or other signs of altered mental status (i.e. agitation, somnolence, repetitive questioning, or slow response to verbal communication). Study outcomes were 1) ciTBI; defined as death, neurosurgery, intubation for >24 hours, or hospitalization for 2 or more nights in association with TBI on CT, and 2) TBI on CT.

Results: Of 5084 (12.0%) children with AMS, 1245 (24.5%) had isolated AMS, of whom 194 (15.6%) were younger than two years, and 1051 (84.4%) were two years or older. Of the 1245, 17 (1.4%, 95% CI 0.8-2.2) children had ciTBI, and 31 (4.0%, 2.7-5.6) of 785 patients who underwent CT scans had TBIs. Of 97 children with isolated GCS scores of 14 (i.e. no other signs of AMS), 1 (1.0%, 0.0-5.6) had ciTBI, as did 12 (1.2%, 0.6-2.0) of 1035 children with isolated other signs of AMS (and GCS scores of 15). Finally, 4 (3.5%, 1.0-8.8) of 113 children with both GCS scores of 14 and other signs of AMS had ciTBI. None underwent neurosurgery.Conclusion(s): In children with isolated AMS following blunt head trauma, depending on the clinical factors present, observation versus computed tomography may be considered.