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BMC Med. 2018 Oct 12;16(1):176. doi: 10.1186/s12916-018-1166-8.

External validation of the Scandinavian guidelines for management of minimal, mild and moderate head injuries in children.

Author information

1
Department of Operation and Intensive Care, Hallands Hospital, Halmstad, Sweden.
2
Lund University, Lund, Sweden.
3
Emergency Department, Starship Children's Health, 2 Park Rd, Grafton, Auckland, 1023, New Zealand.
4
Liggins Institute, University of Auckland, 85 Park Ave, Grafton, Auckland, 1023, New Zealand.
5
Emergency Department, Princess Margaret Hospital for Children, Roberts Rd, Subiaco, Perth, Western Australia, 6008, Australia.
6
Divisions of Paediatrics and Emergency Medicine, School of Medicine, University of Western Australia, 35 Stirling Hwy, Crawley, Western Australia, 6009, Australia.
7
Emergency Department, Lady Cilento Children's Hospital, Brisbane and Child Health Research Centre, School of Medicine, The University of Queensland, 501 Stanley St, South Brisbane, Queensland, 4101, Australia.
8
Emergency Department, Women's & Children's Hospital, Adelaide, 72 King William St, North Adelaide, South Australia, 5006, Australia.
9
Murdoch Children's Research Institute, Melbourne, 50 Flemington Rd, Parkville, Victoria, 3052, Australia.
10
Emergency Department, Bristol Children's Hospital, Paul O'Gorman Building, Upper Maudlin St, Bristol, BS2 8BJ, UK.
11
Academic Department of Emergency Care, University of the West of England, Blackberry Hill, Bristol, BS16 1XS, UK.
12
Department of Women's and Children's Health, University of Padova, Via Giustiniani3, 2, 35128, Padova, Padova, Italy.
13
Department of Emergency Medicine, Royal Children's Hospital, 50 Flemington Rd, Parkville, Victoria, 3052, Australia.
14
Emergency Department, Monash Medical Centre, 246 Clayton Rd, Clayton, Victoria, 3186, Australia.
15
Emergency Department, Kidzfirst Middlemore Hospital, 100 Hospital Rd, Auckland, 2025, New Zealand.
16
Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Grattan St, Parkville, Victoria, 3010, Australia.
17
Emergency Department, The Children's Hospital at Westmead, 212 Hawkesbury Rd, Westmead, New South Wales, 2145, Australia.
18
Department of Emergency Medicine, Royal Children's Hospital, 50 Flemington Rd, Parkville, Victoria, 3052, Australia. franz.babl@rch.org.au.
19
Murdoch Children's Research Institute, Melbourne, 50 Flemington Rd, Parkville, Victoria, 3052, Australia. franz.babl@rch.org.au.
20
Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Grattan St, Parkville, Victoria, 3010, Australia. franz.babl@rch.org.au.

Abstract

BACKGROUND:

Clinical decision rules (CDRs) aid in the management of children with traumatic brain injury (TBI). Recently, the Scandinavian Neurotrauma Committee (SNC) has published practical, evidence-based guidelines for children with Glasgow Coma Scale (GCS) scores of 9-15. This study aims to validate these guidelines and to compare them with other CDRs.

METHODS:

A large prospective cohort of children (< 18 years) with TBI of all severities, from ten Australian and New Zealand hospitals, was used to assess the SNC guidelines. Firstly, a validation study was performed according to the inclusion and exclusion criteria of the SNC guideline. Secondly, we compared the accuracy of SNC, CATCH, CHALICE and PECARN CDRs in patients with GCS 13-15 only. Diagnostic accuracy was calculated for outcome measures of need for neurosurgery, clinically important TBI (ciTBI) and brain injury on CT.

RESULTS:

The SNC guideline could be applied to 19,007/20,137 of patients (94.4%) in the validation process. The frequency of ciTBI decreased significantly with stratification by decreasing risk according to the SNC guideline. Sensitivities for the detection of neurosurgery, ciTBI and brain injury on CT were 100.0% (95% CI 89.1-100.0; 32/32), 97.8% (94.5-99.4; 179/183) and 95% (95% CI 91.6-97.2; 262/276), respectively, with a CT/admission rate of 42% (mandatory CT rate of 5%, 18% CT or admission and 19% only admission). Four patients with ciTBI were missed; none needed specific intervention. In the homogenous comparison cohort of 18,913 children, the SNC guideline performed similar to the PECARN CDR, when compared with the other CDRs.

CONCLUSION:

The SNC guideline showed a high accuracy in a large external validation cohort and compares well with published CDRs for the management of paediatric TBI.

KEYWORDS:

Child; Clinical decision rule; Computed tomography; Guideline; Head injury; Head trauma; Infant; Scandinavia

PMID:
30309392
PMCID:
PMC6182797
DOI:
10.1186/s12916-018-1166-8
[Indexed for MEDLINE]
Free PMC Article

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