Wickbom Fredrik, Bremell Rakel, Thornberg Sarah, Sotoca Fernandez Jorge, Magnusson Beatrice, Silfver Rasmus, Chaudhry Aqeel, Kjellröier Kristoffer, Farahnoosh Afsan Hanna, Bergman Marcus, Jumppanen Amel, Johansson Malin, Östberg Sascha, Kamis Christian, Ölund Mihai, Jeppsson Emma, Modin Albert, Santoft Anders, Borg Lovisa, Gatzinsky Cathrine, Lönn Maria, Calcagnile Olga, Astrand Ramona, Sundstrøm Terje, Marklund Niklas, Undén Johan
Department of Clinical Sciences, Malmö, Lund University Faculty of Medicine, Lund, Sweden.
Department of Operation and Intensive Care, Halland Hospital Halmstad, Region Halland, Halmstad, Sweden.
Lancet Reg Health Eur. 2025 Feb 13;51:101233. doi: 10.1016/j.lanepe.2025.101233. eCollection 2025 Apr.
Current guidelines for initial management of traumatic brain injury (TBI) support decision making, but they are rarely validated. The Scandinavian guideline for management of children with TBI (SNC16) was developed to minimise the use of cranial computed tomography (cCT) without compromising safety, but the performance of the guideline in a real-world population is unknown. We aimed to determine the diagnostic accuracy for the SNC16 in a large, pragmatic cohort of children.
In this prospective, observational, international cohort study in 16 Swedish and Norwegian emergency departments (EDs), children (aged <18 years) with blunt head trauma, presenting within 24 h of injury and a Glasgow Coma Scale of 9-15, were prospectively enrolled. The primary outcome measure was presence of a composite variable (clinically important intracranial injury (CIII) comprised of death, neurosurgery, admission to hospital ward ≥2 days due to head injury, or intubation ≥1 day due to pathological cCT findings), all within one week from trauma. Secondary outcome measures were neurosurgery and significant trauma related findings on cCT.
A total of 3012 children were enrolled from April 2018 to May 2024. Nine patients fulfilled the primary variable CIII (0.30%; 9/3012), two patients required neurosurgery (0.07%; 2/3012), and 27 patients showed significant trauma related findings on cCT (0.90%; 27/3012). Point sensitivities to detect CIII, neurosurgery and significant cCT findings were 100% (CI 95% 70%-100% [9/9]; 34%-100% [2/2]; and 87%-100% [27/27]). Point specificity was 41.3%, 41.2%, and 41.6% (CI 95% 40%-43% [1241/3003]; 39%-43% [1241/3010]; and 40%-43% [1241/2985]). Negative predictive values were 100% for CIII, neurosurgery and significant cCT findings (CI 95% 99.7%-100.0% for all). Application of the SNC16 guidelines would have resulted in a mandatory cCT rate of 3.4% (101/3012) and immediate discharge from the ED for 41.2% (1241/3012) of children. No children with a discharge recommendation were positive for any primary or secondary outcomes.
Validation of the SNC16 guideline showed adequate diagnostic performance in a real-world cohort, supporting formal implementation.
Non-commercially (Swedish state) funded by Sӧdra Sjukvårdsregionen and Vetenskapliga Rådet, Hallands Hospital and Forskning och Utveckling, Halland.
目前关于创伤性脑损伤（TBI）初始管理的指南有助于决策制定，但很少经过验证。制定斯堪的纳维亚儿童TBI管理指南（SNC16）的目的是在不影响安全性的情况下尽量减少头颅计算机断层扫描（cCT）的使用，但该指南在现实人群中的表现尚不清楚。我们旨在确定SNC16在一个大型实用儿童队列中的诊断准确性。
在这项针对瑞典和挪威16个急诊科的前瞻性、观察性国际队列研究中，前瞻性纳入了年龄小于18岁、在受伤后24小时内就诊且格拉斯哥昏迷量表评分为9 - 15分的钝性头部外伤儿童。主要结局指标是一个复合变量的存在情况（临床上重要的颅内损伤（CIII），包括死亡、神经外科手术、因头部损伤住院病房≥2天或因病理性cCT结果插管≥1天），所有这些均在创伤后一周内。次要结局指标是神经外科手术以及cCT上与创伤相关的重要发现。
2018年4月至2024年5月共纳入3012名儿童。9名患者符合主要变量CIII（0.30%；9/3012），2名患者需要神经外科手术（0.07%；2/3012），27名患者在cCT上显示与创伤相关的重要发现（0.90%；27/3012）。检测CIII、神经外科手术和cCT重要发现的点敏感性分别为100%（95%CI 70% - 100%[9/9]；34% - 100%[2/2]；87% - 100%[27/27]）。点特异性分别为41.3%、41.2%和41.6%（95%CI 40% - 43%[1241/3003]；39% - 43%[1241/3010]；40% - 43%[1241/2985]）。CIII、神经外科手术和cCT重要发现的阴性预测值均为100%（所有95%CI 99.7% - 100.0%）。应用SNC16指南将使强制cCT率为3.4%（101/3012），41.2%（1241/3012）的儿童可从急诊科立即出院。没有任何出院建议的儿童出现任何主要或次要结局阳性。
SNC16指南的验证表明其在现实队列中具有足够的诊断性能，支持正式实施。
由南瑞典地区医疗保健局和瑞典研究理事会非商业性（瑞典政府）资助，哈兰医院以及哈兰研究与发展中心参与。
Zotero 插件
