External validation of the Scandinavian guidelines for management of minimal, mild and moderate head injuries in children

BMC Medicine

on behalf of the Paediatric Research in Emergency Departments International Collaborative (PREDICT)¹  Ed Oakley²  John A. Cheek²  Franz E. Babl²  Johan Undén³  Jocelyn Neutze⁴  Yuri Gilhotra⁵  Natalie Phillips⁵  Meredith L. Borland⁶  Stuart R. Dalziel⁷  Sarah Dalton⁸  Amit Kochar⁹  Silvia Bressan^1,10  Stephen Hearps^1,10  Mark D. Lyttle^1,10  Susan Donath^1,10 

[1] ;Department of Emergency Medicine, Royal Children’s Hospital;Department of Operation and Intensive Care, Hallands Hospital;Emergency Department, Kidzfirst Middlemore Hospital;Emergency Department, Lady Cilento Children’s Hospital, Brisbane and Child Health Research Centre, School of Medicine, The University of Queensland;Emergency Department, Princess Margaret Hospital for Children;Emergency Department, Starship Children’s Health;Emergency Department, The Children’s Hospital at Westmead;Emergency Department, Women’s & Children’s Hospital, Adelaide;Murdoch Children’s Research Institute, Melbourne;

关键词: Head trauma;    Head injury;    Guideline;    Clinical decision rule;    Infant;    Child;   

DOI  :  10.1186/s12916-018-1166-8

来源: DOAJ

【 摘 要 】

Abstract Background Clinical decision rules (CDRs) aid in the management of children with traumatic brain injury (TBI). Recently, the Scandinavian Neurotrauma Committee (SNC) has published practical, evidence-based guidelines for children with Glasgow Coma Scale (GCS) scores of 9–15. This study aims to validate these guidelines and to compare them with other CDRs. Methods A large prospective cohort of children (< 18 years) with TBI of all severities, from ten Australian and New Zealand hospitals, was used to assess the SNC guidelines. Firstly, a validation study was performed according to the inclusion and exclusion criteria of the SNC guideline. Secondly, we compared the accuracy of SNC, CATCH, CHALICE and PECARN CDRs in patients with GCS 13–15 only. Diagnostic accuracy was calculated for outcome measures of need for neurosurgery, clinically important TBI (ciTBI) and brain injury on CT. Results The SNC guideline could be applied to 19,007/20,137 of patients (94.4%) in the validation process. The frequency of ciTBI decreased significantly with stratification by decreasing risk according to the SNC guideline. Sensitivities for the detection of neurosurgery, ciTBI and brain injury on CT were 100.0% (95% CI 89.1–100.0; 32/32), 97.8% (94.5–99.4; 179/183) and 95% (95% CI 91.6–97.2; 262/276), respectively, with a CT/admission rate of 42% (mandatory CT rate of 5%, 18% CT or admission and 19% only admission). Four patients with ciTBI were missed; none needed specific intervention. In the homogenous comparison cohort of 18,913 children, the SNC guideline performed similar to the PECARN CDR, when compared with the other CDRs. Conclusion The SNC guideline showed a high accuracy in a large external validation cohort and compares well with published CDRs for the management of paediatric TBI.

【 授权许可】

Unknown