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Pediatric head trauma is one of the most common reasons for consultation in the ED, and can be mild, moderate or severe. The most common causes of head trauma in children and youth presenting to Canadian EDs include falls, sports-related injuries, being hit on the head by an object or by colliding with an obstacle, or injuries involving bicycles and motor vehicles. Annual rates range from 130 to 200 cases per 100,000 population, leading to at least 20,000 emergency department visits in Canadian pediatric hospitals per year.

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Key studies English (21) French All (21)

Key Study: Validation and refinement of a clinical decision rule for the use of computed tomography in children with minor head injury in the emergency department

Visit

Osmond MH, Klassen TP, Wells GA, Davidson J, Correll R, Boutis K, Joubert G, ...

Methods: This multicentre cohort study in 9 Canadian pediatric emergency departments prospectively enrolled children with blunt head trauma presenting with a Glasgow Coma Scale score of 13-15 and loss of consciousness, amnesia, disorientation, persistent vomiting or irritability. Physicians completed standardized assessment forms before CT, including clinical predictors of the rule. The primary outcome was neurosurgical intervention and the secondary outcome was brain injury on CT. We calculated test characteristics of the rule and used recursive partitioning to further refine the rule.

Key Study: Examining Emergency Department Treatment Processes in Severe Pediatric Traumatic Brain Injury

Visit

Ajdari A, Boyle LN, Kannan N, Rowhani-Rahbar A, Wang J, Mink R, Ries B, Wainw...

Our objectives were to examine the treatment process of acute pediatric TBI and the impact of non-value-added time (NVAT) on patient outcomes.

Key Study: Big for Small; Validating Brain Injury Guidelines in Pediatric Traumatic Brain Injury

Visit

Azim A, Jehan FS, Rhee P, O'Keeffe T, Tang A, Vercruysse G, Kulvatunyou N, La...

The aim of this study was to evaluate the established BIG (BIG-1 category) for managing pediatric traumatic brain injury (TBI) patients with intracranial hemorrhage (ICH) without NC (no-NC).

Key Study: Reducing Head CT Use for Children With Head Injuries in a Community Emergency Department

Visit

Jennings RM, Burtner JJ, Pellicer JF, Nair DK, Bradford MC, Shaffer M, Uspal ...

Clinical decision rules have reduced use of computed tomography (CT) to evaluate minor pediatric head injury in pediatric emergency departments (EDs). CT use remains high in community EDs, where the majority of children seek medical care. We sought to reduce the rate of CT scans used to evaluate pediatric head injury from 29% to 20% in a community ED.

Key Study: Prevalence and Impact of Admission Acute Traumatic Coagulopathy on Treatment Intensity, Resource Use, and Mortality: An Evaluation of 956 Severely Injured Children and Adolescents

Visit

Liras IN, Caplan HW, Stensballe J, Wade CE, Cox CS, Cotton BA

The purpose of this study was to assess the prevalence and impact of arrival coagulopathy, determined by viscoelastic hemostatic testing, in severely injured children.

Key Study: Tripartite Stratification of the Glasgow Coma Scale in Children with Severe Traumatic Brain Injury and Mortality: An Analysis from a Multi-Center Comparative Effectiveness Study

Visit

Murphy S, Thomas NJ, Gertz SJ, Beca J, Luther JF, Bell MJ, Wisniewski SR, Har...

This study describes the distribution of GCS scores in the population, the relationship between injury characteristics with the GCS score, and the association between the tripartite stratification of the GCS on mortality in children with severe traumatic brain injury (TBI).

Key Study: Investigating the Connection Between Traumatic Brain Injury and Posttraumatic Stress Symptoms in Adolescents

Visit

Rhine T, Cassedy A, Yeates KO, Taylor HG, Kirkwood MW, Wade SL

To identify potentially modifiable individual and social-environmental correlates of posttraumatic stress symptoms (PTSS) among adolescents hospitalized for traumatic brain injury (TBI).

Key Study: Development and implementation of a standardized pathway in the Pediatric Intensive Care Unit for children with severe traumatic brain injuries

Visit

Rakes L, King M, Johnston B, Chesnut R, Grant R, Vavilala M

The aim of this quality improvement project was to increase TBI guideline adherence by implementing a standard care pathway for PICU management of children with severe TBI.

Key Study: Are CT scans obtained at referring institutions justified prior to transfer to a pediatric trauma center?

Visit

Benedict LA, Paulus JK, Rideout L, Chwals WJ

To assess whether pediatrictraumapatientsinitially evaluated at referring institutions met Massachusetts statewidetraumafield triage criteria for stabilization and immediate transfer to a PediatricTraumaCenter (PTC) without pre-transfer CT imaging.

Key Study: Acute care clinical indicators associated with discharge outcomes in children with severe traumatic brain injury

Visit

Vavilala MS, Kernic MA, Wang J, Kannan N, Mink RB, Wainwright MS, Groner JI, ...

The effect of the 2003 severe pediatric traumatic brain injury (TBI) guidelines on outcomes has not been examined. We aimed to develop a set ofacutecare guideline-influenced clinical indicators of adherence and tested the relationship between these indicators during the first 72 hours after hospital admission and discharge outcomes.

Key Study: Comparison of hypothermia and normothermia after severe traumatic brain injury in children (Cool Kids): a phase 3, randomised controlled trial

Visit

Adelson PD, Wisniewski SR, Beca J, Brown SD, Bell M, Muizelaar JP, Okada P, B...

On the basis of mixed results from previous trials, we assessed whether therapeutic hypothermia for 48-72 h with slow rewarming improved mortality in children after brain injury.

Key Study: Differences in medical therapy goals for children with severe traumatic brain injury-an international study

Visit

Bell MJ, Adelson PD, Hutchison JS, Kochanek PM, Tasker RC, Vavilala MS, Beers...

To describe the differences in goals for their usual practice for various medical therapies from a number of international centers for children with severe traumatic brain injury.

Key Study: The emerging use of ketamine for anesthesia and sedation in traumatic brain injuries

Visit

Chang LC, Raty SR, Ortiz J, Bailard NS, Mathew SJ

This article reviews the current literature in regards to using ketamine inpatientswith traumatic brain injuries in different clinical settings associated with anesthesia, as well as reviews the potential mechanisms underlying the neuroprotective effects of ketamine.

Key Study: Early coagulopathy is an independent predictor of mortality in children after severe trauma

Visit

Whittaker B, Christiaans SC, Altice JL, Chen MK, Bartolucci AA, Morgan CJ, Ke...

To determine whether early coagulopathy affects the mortality associated with severe civilian pediatrictrauma,traumapatientsyounger than 18 years admitted to a pediatric intensive care unit from 2001 to 2010 were evaluated.

Key Study: Ability of emergency ultrasonography to detect pediatric skull fractures: a prospective, observational study

Visit

Parri N, Crosby BJ, Glass C, Mannelli F, Sforzi I, Schiavone R, Ban KM

Our objective was to determine if bedside ED ultrasound is an accurate diagnostic tool for identifying skull fractures when compared toheadCT.

Key Study: CATCH: a clinical decision rule for the use of computed tomography in children with minor head injury

Visit

Osmond MH, Klassen TP, Wells GA, Correll R, Jarvis A, Joubert G, Bailey B, Ch...

There is controversy about which children with minorheadinjury need to undergo computed tomography (CT). We aimed to develop a highly sensitive clinical decision rule for the use of CT in children with minorheadinjury.

Key Study: Early resuscitation of children with moderate-to-severe traumatic brain injury

Visit

Zebrack M, Dandoy C, Hansen K, Scaife E, Mann NC, Bratton SL

The purpose of this study was to identify the prevalence, monitoring, and treatment of hypotension and hypoxia during "early" (prehospital and emergency department) care and to evaluate their relationship to vital status and neurologic outcomes at hospital discharge.

Key Study: Identification of children at very low risk of clinically-important brain injuries after head trauma: a prospective cohort study

Visit

Kuppermann N, Holmes JF, Dayan PS, Hoyle JD, Atabaki SM, Holubkov R, Nadel FM...

CT imaging ofhead-injured children has risks of radiation-induced malignancy. Our aim was to identify children at very low risk of clinically-important traumatic brain injuries (ciTBI) for whom CT might be unnecessary.

Key Study: Long-term outcomes and prognostic factors in pediatric patients with severe traumatic brain injury and elevated intracranial pressure

Visit

Jagannathan J, Okonkwo DO, Yeoh HK, Dumont AS, Saulle D, Haizlip J, Barth JT,...

Themanagementstrategies and outcomes in pediatricpatientswith elevated intracranial pressure (ICP) following severe traumatic brain injury (TBI) are examined in this study.

Key Study: Reliability and validity of the Pediatric Intensity Level of Therapy (PILOT) scale: a measure of the use of intracranial pressure-directed therapies

Visit

Shore PM, Hand LL, Roy L, Trivedi P, Kochanek PM, Adelson PD

To test the reliability and validity of the Pediatric Intensity Level of Therapy (PILOT) scale, a novel measure of overall therapeutic effort directed at controlling intracranial pressure (ICP) in the setting of severe (Glasgow Coma Scale of

Key Study: Clinical significance of scalp abnormalities in asymptomatic head-injured infants

Visit

Greenes DS, Schutzman SA

Objectives: 1) To identify clinical features indicating a high risk of skull fracture (SF) and associated intracranial injury (ICI) in asymptomatichead-injured infants. 2) To develop a clinical decision rule to determine which asymptomatichead-injured infants requireheadimaging.

Key Study: Validation and refinement of a clinical decision rule for the use of computed tomography in children with minor head injury in the emergency department

Visit

Osmond MH, Klassen TP, Wells GA, Davidson J, Correll R, Boutis K, Joubert G, ...

Methods: This multicentre cohort study in 9 Canadian pediatric emergency departments prospectively enrolled children with blunt head trauma presenting with a Glasgow Coma Scale score of 13-15 and loss of consciousness, amnesia, disorientation, persistent vomiting or irritability. Physicians completed standardized assessment forms before CT, including clinical predictors of the rule. The primary outcome was neurosurgical intervention and the secondary outcome was brain injury on CT. We calculated test characteristics of the rule and used recursive partitioning to further refine the rule.

Key Study: Examining Emergency Department Treatment Processes in Severe Pediatric Traumatic Brain Injury

Visit

Ajdari A, Boyle LN, Kannan N, Rowhani-Rahbar A, Wang J, Mink R, Ries B, Wainw...

Our objectives were to examine the treatment process of acute pediatric TBI and the impact of non-value-added time (NVAT) on patient outcomes.

Key Study: Big for Small; Validating Brain Injury Guidelines in Pediatric Traumatic Brain Injury

Visit

Azim A, Jehan FS, Rhee P, O'Keeffe T, Tang A, Vercruysse G, Kulvatunyou N, La...

The aim of this study was to evaluate the established BIG (BIG-1 category) for managing pediatric traumatic brain injury (TBI) patients with intracranial hemorrhage (ICH) without NC (no-NC).

Key Study: Reducing Head CT Use for Children With Head Injuries in a Community Emergency Department

Visit

Jennings RM, Burtner JJ, Pellicer JF, Nair DK, Bradford MC, Shaffer M, Uspal ...

Clinical decision rules have reduced use of computed tomography (CT) to evaluate minor pediatric head injury in pediatric emergency departments (EDs). CT use remains high in community EDs, where the majority of children seek medical care. We sought to reduce the rate of CT scans used to evaluate pediatric head injury from 29% to 20% in a community ED.

Key Study: Prevalence and Impact of Admission Acute Traumatic Coagulopathy on Treatment Intensity, Resource Use, and Mortality: An Evaluation of 956 Severely Injured Children and Adolescents

Visit

Liras IN, Caplan HW, Stensballe J, Wade CE, Cox CS, Cotton BA

The purpose of this study was to assess the prevalence and impact of arrival coagulopathy, determined by viscoelastic hemostatic testing, in severely injured children.

Key Study: Tripartite Stratification of the Glasgow Coma Scale in Children with Severe Traumatic Brain Injury and Mortality: An Analysis from a Multi-Center Comparative Effectiveness Study

Visit

Murphy S, Thomas NJ, Gertz SJ, Beca J, Luther JF, Bell MJ, Wisniewski SR, Har...

This study describes the distribution of GCS scores in the population, the relationship between injury characteristics with the GCS score, and the association between the tripartite stratification of the GCS on mortality in children with severe traumatic brain injury (TBI).

Key Study: Investigating the Connection Between Traumatic Brain Injury and Posttraumatic Stress Symptoms in Adolescents

Visit

Rhine T, Cassedy A, Yeates KO, Taylor HG, Kirkwood MW, Wade SL

To identify potentially modifiable individual and social-environmental correlates of posttraumatic stress symptoms (PTSS) among adolescents hospitalized for traumatic brain injury (TBI).

Key Study: Development and implementation of a standardized pathway in the Pediatric Intensive Care Unit for children with severe traumatic brain injuries

Visit

Rakes L, King M, Johnston B, Chesnut R, Grant R, Vavilala M

The aim of this quality improvement project was to increase TBI guideline adherence by implementing a standard care pathway for PICU management of children with severe TBI.

Key Study: Are CT scans obtained at referring institutions justified prior to transfer to a pediatric trauma center?

Visit

Benedict LA, Paulus JK, Rideout L, Chwals WJ

To assess whether pediatrictraumapatientsinitially evaluated at referring institutions met Massachusetts statewidetraumafield triage criteria for stabilization and immediate transfer to a PediatricTraumaCenter (PTC) without pre-transfer CT imaging.

Key Study: Acute care clinical indicators associated with discharge outcomes in children with severe traumatic brain injury

Visit

Vavilala MS, Kernic MA, Wang J, Kannan N, Mink RB, Wainwright MS, Groner JI, ...

The effect of the 2003 severe pediatric traumatic brain injury (TBI) guidelines on outcomes has not been examined. We aimed to develop a set ofacutecare guideline-influenced clinical indicators of adherence and tested the relationship between these indicators during the first 72 hours after hospital admission and discharge outcomes.

Key Study: Comparison of hypothermia and normothermia after severe traumatic brain injury in children (Cool Kids): a phase 3, randomised controlled trial

Visit

Adelson PD, Wisniewski SR, Beca J, Brown SD, Bell M, Muizelaar JP, Okada P, B...

On the basis of mixed results from previous trials, we assessed whether therapeutic hypothermia for 48-72 h with slow rewarming improved mortality in children after brain injury.

Key Study: Differences in medical therapy goals for children with severe traumatic brain injury-an international study

Visit

Bell MJ, Adelson PD, Hutchison JS, Kochanek PM, Tasker RC, Vavilala MS, Beers...

To describe the differences in goals for their usual practice for various medical therapies from a number of international centers for children with severe traumatic brain injury.

Key Study: The emerging use of ketamine for anesthesia and sedation in traumatic brain injuries

Visit

Chang LC, Raty SR, Ortiz J, Bailard NS, Mathew SJ

This article reviews the current literature in regards to using ketamine inpatientswith traumatic brain injuries in different clinical settings associated with anesthesia, as well as reviews the potential mechanisms underlying the neuroprotective effects of ketamine.

Key Study: Early coagulopathy is an independent predictor of mortality in children after severe trauma

Visit

Whittaker B, Christiaans SC, Altice JL, Chen MK, Bartolucci AA, Morgan CJ, Ke...

To determine whether early coagulopathy affects the mortality associated with severe civilian pediatrictrauma,traumapatientsyounger than 18 years admitted to a pediatric intensive care unit from 2001 to 2010 were evaluated.

Key Study: Ability of emergency ultrasonography to detect pediatric skull fractures: a prospective, observational study

Visit

Parri N, Crosby BJ, Glass C, Mannelli F, Sforzi I, Schiavone R, Ban KM

Our objective was to determine if bedside ED ultrasound is an accurate diagnostic tool for identifying skull fractures when compared toheadCT.

Key Study: CATCH: a clinical decision rule for the use of computed tomography in children with minor head injury

Visit

Osmond MH, Klassen TP, Wells GA, Correll R, Jarvis A, Joubert G, Bailey B, Ch...

There is controversy about which children with minorheadinjury need to undergo computed tomography (CT). We aimed to develop a highly sensitive clinical decision rule for the use of CT in children with minorheadinjury.

Key Study: Early resuscitation of children with moderate-to-severe traumatic brain injury

Visit

Zebrack M, Dandoy C, Hansen K, Scaife E, Mann NC, Bratton SL

The purpose of this study was to identify the prevalence, monitoring, and treatment of hypotension and hypoxia during "early" (prehospital and emergency department) care and to evaluate their relationship to vital status and neurologic outcomes at hospital discharge.

Key Study: Identification of children at very low risk of clinically-important brain injuries after head trauma: a prospective cohort study

Visit

Kuppermann N, Holmes JF, Dayan PS, Hoyle JD, Atabaki SM, Holubkov R, Nadel FM...

CT imaging ofhead-injured children has risks of radiation-induced malignancy. Our aim was to identify children at very low risk of clinically-important traumatic brain injuries (ciTBI) for whom CT might be unnecessary.

Key Study: Long-term outcomes and prognostic factors in pediatric patients with severe traumatic brain injury and elevated intracranial pressure

Visit

Jagannathan J, Okonkwo DO, Yeoh HK, Dumont AS, Saulle D, Haizlip J, Barth JT,...

Themanagementstrategies and outcomes in pediatricpatientswith elevated intracranial pressure (ICP) following severe traumatic brain injury (TBI) are examined in this study.

Key Study: Reliability and validity of the Pediatric Intensity Level of Therapy (PILOT) scale: a measure of the use of intracranial pressure-directed therapies

Visit

Shore PM, Hand LL, Roy L, Trivedi P, Kochanek PM, Adelson PD

To test the reliability and validity of the Pediatric Intensity Level of Therapy (PILOT) scale, a novel measure of overall therapeutic effort directed at controlling intracranial pressure (ICP) in the setting of severe (Glasgow Coma Scale of

Key Study: Clinical significance of scalp abnormalities in asymptomatic head-injured infants

Visit

Greenes DS, Schutzman SA

Objectives: 1) To identify clinical features indicating a high risk of skull fracture (SF) and associated intracranial injury (ICI) in asymptomatichead-injured infants. 2) To develop a clinical decision rule to determine which asymptomatichead-injured infants requireheadimaging.