A clinical decision rule for cranial computed tomography in minor pediatric head trauma.
OBJECTIVE
To develop a sensitive clinical decision rule with a high negative predictive value for the use of cranial computed tomography (CT) in minor pediatric head trauma, to identify clinical features predictive of neurosurgical intervention, and to assess clinicians' predictive abilities to determine the presence or absence of intracranial injury based on history and physical examination alone.


METHODS
Prospective observational study.


METHODS
Four level I pediatric trauma centers.


METHODS
One thousand patients younger than 21 years with minor head trauma undergoing cranial CT.


METHODS
Intracranial injury as demonstrated by CT and neurosurgical intervention.


RESULTS
Of 1000 patients in the study, the mean age was 8.9 years, and 64.1% were male; 6.5% (65 of 1000) had positive findings on CT, and 9.2% (6 of 65) of these required neurosurgical intervention. Recursive partitioning identified the following variables in the decision rule: dizziness, skull defect, sensory deficit, mental status change, bicycle-related injury, age younger than 2 years, Glasgow Coma Scale score less than 15, and evidence of a basilar skull fracture. For detection of intracranial injury, the decision rule had a sensitivity of 95.4% (95% confidence interval [CI], 86.2%-98.8%), a specificity of 48.9% (95% CI, 46.6%-52.1%), and a negative predictive value of 99.3% (95% CI, 98.1%-99.8%).


CONCLUSIONS
We developed a sensitive clinical decision rule with a high NPV for detection of intracranial injury in minor pediatric head trauma. If validated, this rule could provide a useful adjunct to the physician's clinical assessment by reducing variations in practice and unnecessary cranial CT.
Atabaki
Shireen M
SM
Division of Emergency Medicine, Children's National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC 20010-2970, USA. satabaki@cnmc.org
Stiell
Ian G
IG
Bazarian
Jeffrey J
JJ
Sadow
Karin E
KE
Vu
Tien T
TT
Camarca
Mary A
MA
Berns
Scott
S
Chamberlain
James M
JM
D000293:Adolescent; D000328:Adult; D000704:Analysis of Variance; D002648:Child; D002675:Child, Preschool; D006259:Craniocerebral Trauma / Q000000981:diagnostic imaging*; D003625:Data Collection; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011446:Prospective Studies; D014057:Tomography, X-Ray Computed / Q000592:standards*