title: [Mild traumatic brain injury in children: can we predict intracranial complications?].
abstract: OBJECTIVE
  To investigate whether clinical signs and symptoms can predict intracranial bleeding (ICB) in children with mild traumatic brain injury.
  
  
  METHODS
  Retrospective chart review.
  
  
  METHODS
  We analysed clinical records from all children (0-18 years) who presented at the Emergency Department or were admitted to the paediatric ward of Isala, a regional trauma centre in Zwolle, the Netherlands, with mild traumatic brain injury between 2011 and 2013. We investigated the predictive value of vomiting, drowsiness, headache, periorbital haematoma, change in behaviour, seizures, amnesia, loss of consciousness and mild neurological symptoms for the presence of ICB by calculating sensitivity, specificity, odds ratio and likelihood ratio.
  
  
  RESULTS
  We analysed data from 410 patients (248 boys; mean [SD] age 4.5 [5.1] years). Most (n = 381, 93%) had normal consciousness on presentation. A CT scan was performed on admission in 84 patients (20.5%); 282 children (68.8%) were admitted for clinical observation (with or without head CT scan) and 51 children (12.4%) were discharged home immediately without imaging or observation. We found ICB in 10 patients (2.4%), only one of whom required neurosurgical intervention. None of the investigated clinical signs and symptoms showed a statistically significant association with bleeding or skull fractures on head CT scan.
  
  
  CONCLUSIONS
  In this study, no clinical sign or symptom could predict the risk of ICB in children with mild traumatic brain injury. Taking the low likelihood of ICB and the radiation damage associated with CT scanning into account, we conclude that a wait-and-see approach without initial imaging is justified and safe in children with mild traumatic brain injury without serious neurological symptoms.
authors.affiliation: Isala, Amalia kindercentrum, Zwolle.
authors.forename: Iris S
authors.initials: IS
authors.lastname: Tilma
authors.forename: Jolita
authors.initials: J
authors.lastname: Bekhof
authors.forename: Paul L P
authors.initials: PL
authors.lastname: Brand
mesh_terms: D000293:Adolescent; D001930:Brain Injuries / Q000150:complications* / Q000175:diagnosis / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D006259:Craniocerebral Trauma / Q000150:complications; D004636:Emergency Service, Hospital; D005260:Female; D006261:Headache / Q000175:diagnosis / Q000209:etiology; D006760:Hospitalization; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D020198:Intracranial Hemorrhage, Traumatic / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology*; D008297:Male; D009426:Netherlands; D012189:Retrospective Studies; D012307:Risk Factors; D012640:Seizures / Q000175:diagnosis / Q000209:etiology; D014057:Tomography, X-Ray Computed