title: Intracranial hemorrhage after blunt head trauma in children with bleeding disorders.
abstract: OBJECTIVE
  To determine computerized tomography (CT) use and prevalence of traumatic intracranial hemorrhage (ICH) in children with and without congenital and acquired bleeding disorders.
  
  
  METHODS
  We compared CT use and ICH prevalence in children with and without bleeding disorders in a multicenter cohort study of 43 904 children <18 years old with blunt head trauma evaluated in 25 emergency departments.
  
  
  RESULTS
  A total of 230 children had bleeding disorders; all had Glasgow Coma Scale (GCS) scores of 14 to 15. These children had higher CT rates than children without bleeding disorders and GCS scores of 14 to 15 (risk ratio, 2.29; 95% CI, 2.15 to 2.44). Of the children who underwent imaging with CT, 2 of 186 children with bleeding disorders had ICH (1.1%; 95% CI, 0.1 to 3.8) , compared with 655 of 14 969 children without bleeding disorders (4.4%; 95% CI, 4.1-4.7; rate ratio, 0.25; 95% CI, 0.06 to 0.98). Both children with bleeding disorders and ICHs had symptoms; none of the children required neurosurgery.
  
  
  CONCLUSIONS
  In children with head trauma, CTs are obtained twice as often in children with bleeding disorders, although ICHs occurred in only 1.1%, and these patients had symptoms. Routine CT imaging after head trauma may not be required in children without symptoms who have congenital and acquired bleeding disorders.
authors.affiliation: Department of Pediatrics, Harvard Medical School, Boston, MA, USA.
authors.forename: Lois K
authors.initials: LK
authors.lastname: Lee
authors.forename: Peter S
authors.initials: PS
authors.lastname: Dayan
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Gerardi
authors.forename: Dominic A
authors.initials: DA
authors.lastname: Borgialli
authors.forename: Mohamed K
authors.initials: MK
authors.lastname: Badawy
authors.forename: James M
authors.initials: JM
authors.lastname: Callahan
authors.forename: Kathleen A
authors.initials: KA
authors.lastname: Lillis
authors.forename: Rachel M
authors.initials: RM
authors.lastname: Stanley
authors.forename: Marc H
authors.initials: MH
authors.lastname: Gorelick
authors.forename: Li
authors.initials: L
authors.lastname: Dong
authors.forename: Sally Jo
authors.initials: SJ
authors.lastname: Zuspan
authors.forename: James F
authors.initials: JF
authors.lastname: Holmes
authors.forename: Nathan
authors.initials: N
authors.lastname: Kuppermann
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D006259:Craniocerebral Trauma / Q000150:complications*; D004636:Emergency Service, Hospital; D005260:Female; D015600:Glasgow Coma Scale; D006402:Hematologic Diseases / Q000150:complications; D006470:Hemorrhage / Q000150:complications*; D006801:Humans; D007223:Infant; D020300:Intracranial Hemorrhages / Q000150:complications*; D008297:Male; D011446:Prospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods