title: Symptomatic blunt head injury in children--a prospective, single-investigator study.
abstract: The goal of this study was to describe a single emergency physician's experience with symptomatic blunt head injury in children and prospectively assess the sensitivity and predictive value of the neurologic examination. The author utilized a prospective patient series comparing neurologic examination with computed tomography (CT) of the head. Nine of 42 patients had intracranial injury for a prevalence of 21%; two patients (5%) had intracranial injury with only subtle neurologic examination findings. Twenty-six patients had a negative neurologic examination, and all had normal-appearing CT scans. Sixteen patients had a positive neurologic examination, of whom nine had a positive CT scan. The properties of the neurologic examination as a diagnostic test, with CT as the gold standard, were as follows: sensitivity = 100%, specificity = 78%, positive predictive value = 56%, negative predictive value = 100%. Normal findings from neurologic examination can be used in some children with symptomatic blunt head injury to delay or eliminate the need for CT of the head.
authors.affiliation: Pediatric Emergency Services, University Medical Center of Southern Nevada, University of Nevada School of Medicine, Las Vegas, USA.
authors.forename: J D
authors.initials: JD
authors.lastname: Fisher
mesh_terms: D002648:Child; D002675:Child, Preschool; D006259:Craniocerebral Trauma; D005260:Female; D006801:Humans; D008297:Male; D009460:Neurologic Examination; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed; D014949:Wounds, Nonpenetrating