title: Presenting characteristics of children who required neurosurgical intervention for head injury.
abstract: OBJECTIVE
  The purpose of this study is to describe the presenting characteristics of a large group of children who required neurosurgical intervention (NSI) following a head injury and to retrospectively assess which of the criteria for imaging from Children's Head Injury Algorithm for the Prediction of Important Clinical Events (CHALICE), Pediatric Emergency Care Applied Research Network (PECARN), and Canadian Assessment of Tomography for Childhood Head Injury (CATCH) clinical decision rules (CDRs) were met by these patients.
  
  
  METHODS
  We retrospectively reviewed all patients undergoing NSI following a head injury, between 2000 and 2008, at a large tertiary pediatric trauma center. We excluded patients having non-accidental injury, other neurosurgical interventions, penetrating injuries, and patients with incomplete data. To those who presented initially with mild head injury (GCS 14-15), we retrospectively applied the criteria for imaging of the CHALICE, PECARN, and CATCH CDRs.
  
  
  RESULTS
  Out of 289 patients undergoing NSI, 182 met inclusion criteria and comprised our cohort. Of the 72 (39.6 %) with mild head injury (GCS 14-15), 71 (98.6 %) met at least one criteria for imaging from each of the three CDRs, including severe mechanism of injury (68, 94.4 %), clinically evident skull fracture (35, 48.6 %), neurological deficit (19, 26.3 %), or severe headache (6, 8.3 %). Of the 182 patients in the entire cohort, only 1 (0.5 %) did not present with an obvious indication for CT on all three CDRs.
  
  
  CONCLUSIONS
  In a large sample of children requiring NSI after head trauma, the vast majority met CT criteria listed in each of the three CDRs. The most common indication for CT was a severe mechanism of injury. This, combined with clinically evident skull fracture, neurological deficit, and severe headache, identifies almost all patients requiring NSI.
authors: Pediatric Emergency Department, Dana Children Hospital, Tel Aviv Soraski Medical Center, 6 Weizmann St., Tel Aviv, Israel. tavororen@gmail.com.
authors: Oren
authors: O
authors: Tavor
authors: Apollo Clinic, Whitfield, Bangalore, India.
authors: Sirisha
authors: S
authors: Boddu
authors: Division of Neurosurgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
authors: Abhaya V
authors: AV
authors: Kulkarni
mesh_terms: D000293:Adolescent; D002170:Canada; D002648:Child; D002675:Child, Preschool; D006259:Craniocerebral Trauma / Q000150:complications / Q000175:diagnosis* / Q000601:surgery*; D005260:Female; D015600:Glasgow Coma Scale; D006261:Headache / Q000209:etiology*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009460:Neurologic Examination; D019635:Neurosurgical Procedures; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012887:Skull Fractures / Q000150:complications / Q000175:diagnosis* / Q000601:surgery*
keywords: CT scan; Head injury; Neurosurgical intervention