Prediction of Clinically Important Traumatic Brain Injury in Pediatric Minor Head Trauma; proposing Pediatric Traumatic Brain Injury (PTBI) Prognostic Rule | ||
| Journal of Pediatric Perspectives | ||
| مقاله 1، دوره 5، شماره 1 - شماره پیاپی 37، فروردین 2017، صفحه 4127-4135 اصل مقاله (705.6 K) | ||
| شناسه دیجیتال (DOI): 10.22038/ijp.2016.8017 | ||
| نویسندگان | ||
| Babak Nakhjavan-Shahraki1؛ Mahmoud Yousefifard2؛ Alireza Oraii3؛ Arash Sarveazad4؛ Mohammad Javad Hajighanbari5؛ Saeed Safari6؛ Alireza Baratloo7؛ Abbas Tafakhori8؛ Mostafa Hosseini* 9 | ||
| 1Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran. | ||
| 2Physiology Research Center and Department of Physiology, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran. | ||
| 3Department of Medicine, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. | ||
| 4Colorectal Research Center, Iran University of Medical Sciences, Tehran, Iran. | ||
| 5Department of Emergency Medicine, Hafte Tir Hospital, Iran University of Medical Sciences, Tehran, Iran. | ||
| 6Department of Emergency Medicine, Shohadaye Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran Iran | ||
| 7Department of Emergency Medicine, Tehran University of Medical Sciences, Tehran, Iran. | ||
| 8Department of Neurology, School of Medicine, Imam Khomeini Hospital and Iranian Center of Neurological Research, Tehran University of Medical Sciences, Tehran, Iran. | ||
| 9Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran. | ||
| چکیده | ||
| Background: The present study assesses independent predictors of clinically important traumatic brain injury (ciTBI) in order to design a prognostic rule for identification of high risk children with mild head injury. Materials and Methods: In a retrospective cross-sectional study, 3,199 children with mild traumatic brain injury (TBI) brought to emergency ward of three hospitals in Tehran, Iran were gathered, from April 2014 to April 2016. The associations between probable predictors of ciTBI in children with mild TBI were assessed and a prediction rule for identification of high risk children in need of computed tomography (CT) scan was designed based on a stepwise multivariate logistic regression. Results: 592 (18.5%) children had ciTBI. History of loss of conciseness (odds ratio [OR]=3.0; p<0.0001), underlying disease (OR=3.6; p=0.002), Glasgow coma scale (GCS) score equal to 14 (OR=40.6; p<0.0001), altered mental status (OR=19.1; p<0.0001), need for intubation (OR=27.4; p<0.0001), presence of vomiting (OR=7.3; p=0.001), and sign of basilar skull fracture (OR=25.9; p=0.007), were the most important prognostic factors of ciTBI in children. Pediatric traumatic brain injury prognostic rule (PTBI prognostic rule) was designed based on these predictors. PTBI prognostic rule had an area under the curve of 0.93, a sensitivity of 100.0%, a specificity of 73.0% and a proper calibration (slope=0.97 and intercept=0.006) in identification of ciTBI. Conclusion: The present study showed that a few of children with mild TBI have ciTBI. Therefore, CT scans are not necessary in all of these children. Using PTBI prognostic rule can reduce the number of unnecessary CT scans. | ||
| کلیدواژهها | ||
| Decision support systems؛ Emergency service؛ Sensitivity and Specificity؛ Pediatrics | ||
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