Department of Women's and Children's Health, University of Padova, Padova, Italy.
Pediatric Emergency, Women's and Children's Hospital Adelaide Women's and Babies Division, North Adelaide, South Australia, Australia.
Arch Dis Child. 2019 Jul;104(7):664-669. doi: 10.1136/archdischild-2018-316066. Epub 2019 Mar 4.
Despite high-quality paediatric head trauma clinical prediction rules, the management of otherwise asymptomatic young children with scalp haematomas (SH) can be difficult. We determined the risk of intracranial injury when SH is the only predictor variable using definitions from the Pediatric Emergency Care Applied Research Network (PECARN) and Children's Head Injury Algorithm for the Prediction of Important Clinical Events (CHALICE) head trauma rules.
Planned secondary analysis of a multicentre prospective observational study.
Ten emergency departments in Australia and New Zealand.
Children <2 years with head trauma (n=5237).
We used the PECARN (any non-frontal haematoma) and CHALICE (>5 cm haematoma in any region of the head) rule-based definition of isolated SH in both children <1 year and <2 years.
Clinically important traumatic brain injury (ciTBI; ie, death, neurosurgery, intubation >24 hours or positive CT scan in association with hospitalisation ≥2 nights for traumatic brain injury).
In children <1 year with isolated SH as per PECARN rule, the risk of ciTBI was 0.0% (0/109; 95% CI 0.0% to 3.3%); in those with isolated SH as defined by the CHALICE, it was 20.0% (7/35; 95% CI 8.4% to 36.9%) with one patient requiring neurosurgery. Results for children <2 years and when using rule specific outcomes were similar.
In young children with SH as an isolated finding after head trauma, use of the definitions of both rules will aid clinicians in determining the level of risk of ciTBI and therefore in deciding whether to do a CT scan.
ACTRN12614000463673.
尽管有高质量的儿科头部创伤临床预测规则，但对于无其他症状的年轻头皮血肿（SH）患儿的处理仍存在困难。我们使用儿科急诊护理应用研究网络（PECARN）和儿童头部创伤重要临床事件预测算法（CHALICE）头部创伤规则的定义，确定 SH 是唯一预测变量时颅内损伤的风险。
一项多中心前瞻性观察研究的计划二次分析。
澳大利亚和新西兰的 10 个急诊部门。
年龄<2 岁的头部创伤患儿（n=5237）。
我们使用 PECARN（任何非额部血肿）和 CHALICE（头部任何区域>5cm 的血肿）规则，对年龄<1 岁和<2 岁的患儿定义孤立性 SH。
临床重要性创伤性脑损伤（ciTBI；即死亡、神经外科手术、>24 小时的插管或与创伤性脑损伤住院≥2 晚相关的阳性 CT 扫描）。
在根据 PECARN 规则诊断为孤立性 SH 的年龄<1 岁的患儿中，ciTBI 的风险为 0.0%（0/109；95%CI 0.0%至 3.3%）；根据 CHALICE 定义为孤立性 SH 的患儿中，ciTBI 的风险为 20.0%（7/35；95%CI 8.4%至 36.9%），其中 1 例需要神经外科手术。对于年龄<2 岁的患儿和使用特定规则的结果，结果相似。
在头部创伤后仅发现 SH 的年幼患儿中，使用这两种规则的定义有助于临床医生确定 ciTBI 的风险水平，从而决定是否进行 CT 扫描。
ACTRN12614000463673。
