title: Traumatic brain injuries and computed tomography use in pediatric sports participants.
abstract: BACKGROUND
  Childhood sports-related head trauma is common, frequently leading to emergency department (ED) visits. We describe the spectrum of these injuries and trends in computed tomography (CT) use in the Pediatric Emergency Care Applied Research Network.
  
  
  METHODS
  This was a secondary analysis of a large prospective cohort of children with head trauma in 25 Pediatric Emergency Care Applied Research Network EDs between 2004 and 2006. We described and compared children 5 to 18 years old by CT rate, traumatic brain injury (TBI) on CT, and clinically important TBI (ciTBI). We used multi-variable logistic regression to compare CT rates, adjusting for clinical severity. Outcomes included frequency of CT, TBIs on CT, and ciTBIs (defined by [a] death, [b] neurosurgery, [c] intubation>24 hours, or [d] hospitalization for ≥2 nights).
  
  
  RESULTS
  A total of 3289 (14%) of 23082 children had sports-related head trauma. Two percent had Glasgow Coma Scale scores less than 14. 53% received ED CTs, 4% had TBIs on CT, and 1% had ciTBIs. Equestrians had increased adjusted odds (1.8; 95% confidence interval [CI], 1.0-3.0]) of CTs; the rate of TBI on CT was 4% (95% CI, 3%-5%). Compared with team sports, snow (adjusted odds ratio, 4.1; 95% CI 1.5-11.4) and nonmotorized wheeled (adjusted odds ratio, 12.8; 95% CI, 5.5-32.4) sports had increased adjusted odds of ciTBIs.
  
  
  CONCLUSIONS
  Children with sports-related head trauma commonly undergo CT. Only 4% of those imaged had TBIs on CT. Clinically important TBIs occurred in 1%, with significant variation by sport. There is an opportunity for injury prevention efforts in high-risk sports and opportunities to reduce CT use in general by use of evidence-based prediction rules. What is known about this subject: Pediatric sports-related head injuries are a common and increasingly frequent ED presentation, as is the use of CT in their evaluation. Little is known about TBIs resulting from different types of sports activities in children. What this study adds to existing knowledge: This study broadens the understanding of the epidemiology of Pediatric TBIs resulting from different sports activities through a prospective assessment of frequency and severity of ciTBIs and ED CT use in a large cohort of head-injured children in a network of pediatric EDs.
authors.affiliation: Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati Ohio, and Department of Pediatrics, Nemours Children's Hospital, Orlando, FL.
authors.forename: Todd
authors.initials: T
authors.lastname: Glass
authors.affiliation: Department of Pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, OH. Electronic address: Richard.ruddy@cchmc.org.
authors.forename: Richard M
authors.initials: RM
authors.lastname: Ruddy
authors.affiliation: Department of Pediatrics, The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, PA.
authors.forename: Elizabeth R
authors.initials: ER
authors.lastname: Alpern
authors.affiliation: Department of Pediatrics, Medical College of Wisconsin, Milwaukee WI.
authors.forename: Marc
authors.initials: M
authors.lastname: Gorelick
authors.affiliation: Departments of Emergency Medicine and Pediatrics, SUNY-Upstate Medical University, Syracuse, NY.
authors.forename: James
authors.initials: J
authors.lastname: Callahan
authors.affiliation: Department of Pediatrics, Harvard Medical School, Boston MA.
authors.forename: Lois
authors.initials: L
authors.lastname: Lee
authors.affiliation: Department of Emergency Medicine, Atlantic Health System, Morristown Memorial Hospital, Morristown, NJ.
authors.forename: Mike
authors.initials: M
authors.lastname: Gerardi
authors.affiliation: Department of Emergency Medicine, Calvert Memorial Hospital, Prince Frederick, MD.
authors.forename: Kraig
authors.initials: K
authors.lastname: Melville
authors.affiliation: Department of Pediatrics and the PECARN Data Coordinating Center, University of Utah, Salt Lake City, UT.
authors.forename: Michelle
authors.initials: M
authors.lastname: Miskin
authors.affiliation: Department of Emergency Medicine, University of California, Davis School of Medicine, Sacramento, CA.
authors.forename: James F
authors.initials: JF
authors.lastname: Holmes
authors.affiliation: Department of Emergency Medicine, University of California, Davis School of Medicine, Sacramento, CA; Department of Pediatrics, University of California, Davis School of Medicine, Sacramento, CA.
authors.forename: Nathan
authors.initials: N
authors.lastname: Kuppermann
mesh_terms: D000293:Adolescent; D001265:Athletic Injuries / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D001930:Brain Injuries / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D009656:North America / Q000453:epidemiology; D015995:Prevalence; D011446:Prospective Studies; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data*