title: Predictors for moderate to severe paediatric head injury derived from a surveillance registry in the emergency department.
abstract: OBJECTIVE
  Head injuries are a common complaint among children presenting to the emergency department (ED). This study is part of an ongoing prospective surveillance of head injured children presenting to a paediatric ED. We aim to derive predictors for moderate to severe head injury in our population.
  
  
  METHODS
  We performed an unmatched case-control study. Cases were defined as those who presented to the ED with moderate to severe head injury, during the period from 2006 to 2014. Controls were obtained from the prospective surveillance head injury database and were children who presented to the ED with head injury but who remained well on follow up. We compared variables from demographics, mechanism of injury, history, and physical examination.
  
  
  RESULTS
  There were 39 cases and 1173 controls. In the prospective database, our event rate was 0.5% and our computed tomography (CT) rate was 1%. Among those with moderate to severe head injury, they were more likely to be involved in road traffic accidents, have a history of difficult arousal, confusion or disorientation and a history of seizure. On physical examination, cases were more likely to have the presence of altered mental status, base of skull fracture, scalp hematoma and anisocoria. On multivariable analysis, the following 4 predictors remained statistically significant: Involvement in road traffic accident (p<0.001), difficult arousal (p<0.001), vomiting (p=0.003) and signs of base of skull fracture (p<0.001). Using these 4 variables, the Area under Curve was 0.97 {Sensitivity 92.3% (79.1-98.4%), Specificity 93.0% (91.4-94.4%), positive predictive value 30.5% (22-40%), negative predictive value 99.7% (99.2-99.9%)}.
  
  
  CONCLUSIONS
  Involvement in road traffic accident, difficult arousal, base of skull fracture and vomiting are independent predictors for moderate to severe head injury in our paediatric population.
authors.affiliation: Department of Emergency Medicine, KK Women's and Children's Hospital, Singapore; SingHealth Duke-NUS Paediatrics Academic Clinical Programme, Duke-NUS Graduate Medical School, Singapore. Electronic address: Chong.Shu-Ling@kkh.com.sg.
authors.forename: Shu-Ling
authors.initials: SL
authors.lastname: Chong
authors.affiliation: Centre for Quantitative Medicine,Duke-NUS Graduate Medical School, Singapore.
authors.forename: Sylvaine
authors.initials: S
authors.lastname: Barbier
authors.affiliation: Centre for Quantitative Medicine,Duke-NUS Graduate Medical School, Singapore; Department of Emergency Medicine, Singapore General Hospital, Singapore.
authors.forename: Nan
authors.initials: N
authors.lastname: Liu
authors.affiliation: Department of Emergency Medicine, KK Women's and Children's Hospital, Singapore; SingHealth Duke-NUS Paediatrics Academic Clinical Programme, Duke-NUS Graduate Medical School, Singapore.
authors.forename: Gene Yong-Kwang
authors.initials: GY
authors.lastname: Ong
authors.affiliation: Department of Emergency Medicine, KK Women's and Children's Hospital, Singapore; SingHealth Duke-NUS Paediatrics Academic Clinical Programme, Duke-NUS Graduate Medical School, Singapore.
authors.forename: Kee Chong
authors.initials: KC
authors.lastname: Ng
authors.affiliation: Department of Emergency Medicine, Singapore General Hospital, Singapore; Health Services and Systems Research, Duke-NUS Graduate Medical School, Singapore.
authors.forename: Marcus Eng Hock
authors.initials: ME
authors.lastname: Ong
mesh_terms: D000063:Accidents, Traffic / Q000401:mortality / Q000706:statistics & numerical data*; D017677:Age Distribution; D001143:Arousal; D001930:Brain Injuries / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D006259:Craniocerebral Trauma / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D042241:Early Diagnosis; D005260:Female; D006776:Hospitals, Pediatric; D006801:Humans; D008297:Male; D017410:Practice Guidelines as Topic; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012846:Singapore / Q000453:epidemiology; D012887:Skull Fractures / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D014057:Tomography, X-Ray Computed; D014193:Trauma Centers; D015599:Trauma Severity Indices; D014839:Vomiting / Q000209:etiology*
keywords: Brain injuries; Children; Paediatrics; Traumatic brain injury