title: Acute evaluation of pediatric patients with minor traumatic brain injury.
abstract: OBJECTIVE
  This review focuses on minor traumatic brain injury (TBI), evaluates the most recent literature regarding clinical prediction rules for the use of cranial computed tomography (CT) in children presenting with minor TBI, reviews the evidence on the need for hospitalization in children with minor TBI, and evaluates the role of S100B testing.
  
  
  RESULTS
  The majority of children presenting to an emergency department (ED) after TBI have a Glasgow Coma Scale (GCS) of 14-15, and the rate of clinically significant intracranial injury is exceedingly rare. Nevertheless, the number of cranial CTs performed in the US has increased dramatically over the past two decades. Several clinical prediction rules have been developed to aid the clinician in identifying children with low-risk TBI, but only the Pediatric Emergency Care Applied Research Network (PECARN) rules have been sufficiently validated to warrant clinical application. Two recent studies provide evidence that children with low-risk TBI can be safely discharged from the ED and do not require prolonged hospitalization for neurologic observation. Lastly, studies evaluating the diagnostic utility of S100B in patients with TBI have shown that it may be a useful adjunct to the clinical evaluation and aid in minimizing neuroimaging.
  
  
  CONCLUSIONS
  Clinical prediction rules, most notably the PECARN rules, can be applied to determine children with low-risk TBI and help decrease unnecessary CT use and hospitalizations. S100B testing requires further investigation, but may serve as an adjunct in determining children with low-risk TBI.
authors.affiliation: Division of Emergency Medicine, Children's National Medical Center, Washington, District of Columbia, USA. MTavarez@cnmc.org
authors.forename: Melissa M
authors.initials: MM
authors.lastname: Tavarez
authors.forename: Shireen M
authors.initials: SM
authors.lastname: Atabaki
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Teach
mesh_terms: D015415:Biomarkers / Q000097:blood; D001930:Brain Injuries / Q000175:diagnosis*; D002648:Child; D003661:Decision Support Techniques; D015600:Glasgow Coma Scale; D006760:Hospitalization; D006801:Humans; D009414:Nerve Growth Factors / Q000097:blood; D064568:S100 Calcium Binding Protein beta Subunit; D009418:S100 Proteins / Q000097:blood; D014057:Tomography, X-Ray Computed
chemical_list: D015415:Biomarkers; D009414:Nerve Growth Factors; D064568:S100 Calcium Binding Protein beta Subunit; D009418:S100 Proteins; C579160:S100B protein, human