nach oben

Pediatric Surgery International

Erschienen in:

17.11.2016 | Original Article

Ambulatory or inpatient management of mild TBI in children: a post-concussion analysis

verfasst von: Danielle S. Wendling-Keim, Adriana König, Hans-Georg Dietz, Markus Lehner

Erschienen in: Pediatric Surgery International | Ausgabe 2/2017

Einloggen, um Zugang zu erhalten

Abstract

Background

Diagnosis and treatment of children with mild traumatic brain injury (mTBI) remain a challenge since initial signs and symptoms do not always indicate the severity of the trauma. Therefore, guidelines regarding the decision upon imaging methods and ambulatory or hospitalized treatment are needed. The goal of our study was to investigate if the standard that was allied from the PECARN rules and is applied in this study can ensure that patients with clinically important brain injury are recognized and leads to outcomes with a low complication rate, a high patient satisfaction and minimal post-concussion syndrome incidence.

Methods

We enrolled 478 children with mTBI and contacted their families with a questionnaire. Out of these, 267 valid questionnaires were received. Patient records and questionnaires were analyzed yielding a number of 140 ambulatory and 127 hospitalized patients.

Results

Patients with mild TBI were admitted according to the above-mentioned guidelines or sent home for observation through their parents after thorough patient examination and information. Among ambulatory patients only 13 children (9%) underwent any imaging procedure; however, none of those showed any pathological findings. Next, in 41 of 127 hospitalized patients (32.2%) an imaging study was performed and of these only 3 according to 2.4% of hospitalized patients showed pathological findings, namely a skull fracture, two of them in combination with an intracranial hemorrhage. The duration of inpatient observation was 48 h in most cases (55.3%). Moreover, a majority of all patients (72.4%) did not seek any follow-up visit and did not need any further treatment. Of all patients in the study, only 10 patients according to 3.7% developed a post-concussion syndrome. Patient satisfaction was very high in both, the ambulatory and hospitalized patient group.

Conclusion

This study confirms that PECARN rules as administered in this study can ensure safe decision-making regarding ambulatory or inpatient treatment.

Casey R, Ludwig S, McCormick MC (1986) Morbidity following minor head trauma in children. Pediatrics 78:497–502PubMed

Stocchetti N, Conte V, Ghisoni L, Canavesi K, Zanaboni C (2010) Traumatic brain injury in pediatric patients. Minerva Anestesiol 76:1052–1059PubMed

Cheng TA, Bell JM, Haileyesus T, Gilchrist J, Sugerman DE, Coronado VG (2016) Nonfatal playground-related traumatic brain injuries among children, 2001–2013. Pediatrics 137(6):e20152721CrossRefPubMed

Rusticali B, Villani R, Working G (2008) Treatment of minor and severe traumatic brain injury. National reference guidelines. Minerva Anestesiol. 74:583–616PubMed

Brain Trauma F (2007) American Association of Neurological S, Congress of Neurological S. Guidelines for the management of severe traumatic brain injury. J Neurotrauma 24(Suppl 1):S1–S106

Adelson PD, Bratton SL, Carney NA, Chesnut RM, du Coudray HE, Goldstein B et al (2003) Guidelines for the acute medical management of severe traumatic brain injury in infants, children, and adolescents. Chapter 3. Prehospital airway management. Pediatr Crit Care Med 4:S9–S11CrossRefPubMed

Adelson PD, Bratton SL, Carney NA, Chesnut RM, du Coudray HE, Goldstein B et al (2003) Guidelines for the acute medical management of severe traumatic brain injury in infants, children, and adolescents. Chapter 4. Resuscitation of blood pressure and oxygenation and prehospital brain-specific therapies for the severe pediatric traumatic brain injury patient. Pediatr Crit Care Med 4:S12–S18CrossRefPubMed

Adelson PD, Bratton SL, Carney NA, Chesnut RM, du Coudray HE, Goldstein B et al (2003) Guidelines for the acute medical management of severe traumatic brain injury in infants, children, and adolescents. Chapter 16. The use of corticosteroids in the treatment of severe pediatric traumatic brain injury. Pediatr Crit Care Med 4:S60–S64CrossRefPubMed

10.

Adelson PD, Bratton SL, Carney NA, Chesnut RM, du Coudray HE, Goldstein B et al (2003) Guidelines for the acute medical management of severe traumatic brain injury in infants, children, and adolescents. Chapter 15. Surgical treatment of pediatric intracranial hypertension. Pediatr Crit Care Med 4:S56–S59CrossRefPubMed

11.

Adelson PD, Bratton SL, Carney NA, Chesnut RM, du Coudray HE, Goldstein B et al (2003) Guidelines for the acute medical management of severe traumatic brain injury in infants, children, and adolescents. Chapter 14. The role of temperature control following severe pediatric traumatic brain injury. Pediatr Crit Care Med 4:S53–S55CrossRefPubMed

12.

Adelson PD, Bratton SL, Carney NA, Chesnut RM, du Coudray HE, Goldstein B et al (2003) Guidelines for the acute medical management of severe traumatic brain injury in infants, children, and adolescents. Chapter 13. The use of barbiturates in the control of intracranial hypertension in severe pediatric traumatic brain injury. Pediatr Crit Care Med 4:S49–S52CrossRefPubMed

13.

Adelson PD, Bratton SL, Carney NA, Chesnut RM, du Coudray HE, Goldstein B et al (2003) Guidelines for the acute medical management of severe traumatic brain injury in infants, children, and adolescents. Chapter 12. Use of hyperventilation in the acute management of severe pediatric traumatic brain injury. Pediatr Crit Care Med 4:S45–S48CrossRefPubMed

14.

Adelson PD, Bratton SL, Carney NA, Chesnut RM, du Coudray HE, Goldstein B et al (2003) Guidelines for the acute medical management of severe traumatic brain injury in infants, children, and adolescents. Chapter 11. Use of hyperosmolar therapy in the management of severe pediatric traumatic brain injury. Pediatr Crit Care Med 4:S40–S44CrossRefPubMed

15.

Adelson PD, Bratton SL, Carney NA, Chesnut RM, du Coudray HE, Goldstein B et al (2003) Guidelines for the acute medical management of severe traumatic brain injury in infants, children, and adolescents. Chapter 10. The role of cerebrospinal fluid drainage in the treatment of severe pediatric traumatic brain injury. Pediatr Crit Care Med 4:S38–S39CrossRefPubMed

16.

Adelson PD, Bratton SL, Carney NA, Chesnut RM, du Coudray HE, Goldstein B et al (2003) Guidelines for the acute medical management of severe traumatic brain injury in infants, children, and adolescents. Chapter 8. Cerebral perfusion pressure. Pediatr Crit Care Med 4:S31–S33CrossRefPubMed

17.

Adelson PD, Bratton SL, Carney NA, Chesnut RM, du Coudray HE, Goldstein B et al (2003) Guidelines for the acute medical management of severe traumatic brain injury in infants, children, and adolescents. Chapter 7. Intracranial pressure monitoring technology. Pediatr Crit Care Med 4:S28–S30CrossRefPubMed

18.

Adelson PD, Bratton SL, Carney NA, Chesnut RM, du Coudray HE, Goldstein B et al (2003) Guidelines for the acute medical management of severe traumatic brain injury in infants, children, and adolescents. Chapter 6. Threshold for treatment of intracranial hypertension. Pediatr Crit Care Med 4:S25–S27CrossRefPubMed

19.

Adelson PD, Bratton SL, Carney NA, Chesnut RM, du Coudray HE, Goldstein B et al (2003) Guidelines for the acute medical management of severe traumatic brain injury in infants, children, and adolescents. Chapter 5. Indications for intracranial pressure monitoring in pediatric patients with severe traumatic brain injury. Pediatr Crit Care Med 4:S19–S24CrossRefPubMed

20.

Adelson PD, Bratton SL, Carney NA, Chesnut RM, du Coudray HE, Goldstein B et al (2003) Guidelines for the acute medical management of severe traumatic brain injury in infants, children, and adolescents. Chapter 2: Trauma systems, pediatric trauma centers, and the neurosurgeon. Pediatr Crit Care Med 4:S5–S8CrossRefPubMed

21.

22.

Adelson PD, Bratton SL, Carney NA, Chesnut RM, du Coudray HE, Goldstein B et al (2003) Guidelines for the acute medical management of severe traumatic brain injury in infants, children, and adolescents. Chapter 9. Use of sedation and neuromuscular blockade in the treatment of severe pediatric traumatic brain injury. Pediatr Crit Care Med 4:S34–S37CrossRefPubMed

23.

Adelson PD, Bratton SL, Carney NA, Chesnut RM, du Coudray HE, Goldstein B et al (2003) Guidelines for the acute medical management of severe traumatic brain injury in infants, children, and adolescents. Chapter 17. Critical pathway for the treatment of established intracranial hypertension in pediatric traumatic brain injury. Pediatr Crit Care Med. 4:S65–S67CrossRefPubMed

24.

Adelson PD, Bratton SL, Carney NA, Chesnut RM, du Coudray HE, Goldstein B et al (2003) Guidelines for the acute medical management of severe traumatic brain injury in infants, children, and adolescents. Chapter 19. The role of anti-seizure prophylaxis following severe pediatric traumatic brain injury. Pediatr Crit Care Med 4:S72–S75CrossRefPubMed

25.

Nigrovic LE, Stack AM, Mannix RC, Lyons TW, Samnaliev M, Bachur RG et al (2015) Quality improvement effort to reduce cranial CTs for children with minor blunt head trauma. Pediatrics 136:e227–e233CrossRefPubMed

26.

Schnadower D, Vazquez H, Lee J, Dayan P, Roskind CG (2007) Controversies in the evaluation and management of minor blunt head trauma in children. Curr Opin Pediatr 19:258–264CrossRefPubMed

27.

Dietrich AM, Bowman MJ, Ginn-Pease ME, Kosnik E, King DR (1993) Pediatric head injuries: can clinical factors reliably predict an abnormality on computed tomography? Ann Emerg Med 22:1535–1540CrossRefPubMed

28.

Kuppermann N, Holmes JF, Dayan PS, Hoyle JD Jr, Atabaki SM, Holubkov R et al (2009) Identification of children at very low risk of clinically-important brain injuries after head trauma: a prospective cohort study. Lancet 374:1160–1170CrossRefPubMed

29.

Schutzman SA, Barnes P, Duhaime AC, Greenes D, Homer C, Jaffe D et al (2001) Evaluation and management of children younger than two years old with apparently minor head trauma: proposed guidelines. Pediatrics 107:983–993CrossRefPubMed

30.

Schutzman SA, Greenes DS (2001) Pediatric minor head trauma. Ann Emerg Med 37:65–74CrossRefPubMed

31.

Pediatrics AAo (1999) The management of minor closed head injury in children. Committee on Quality Improvement, American Academy of Pediatrics. Commission on Clinical Policies and Research. American Academy of Family Physicians. Pediatrics 104:1407–1415CrossRef

32.

Schonfeld D, Bressan S, Da Dalt L, Henien MN, Winnett JA, Nigrovic LE (2014) Pediatric Emergency Care Applied Research Network head injury clinical prediction rules are reliable in practice. Arch Dis Child 99:427–431CrossRefPubMed

33.

King NS, Crawford S, Wenden FJ, Moss NE, Wade DT (1995) The Rivermead post concussion symptoms questionnaire: a measure of symptoms commonly experienced after head injury and its reliability. J Neurol 242:587–592CrossRefPubMed

34.

Potter S, Leigh E, Wade D, Fleminger S (2006) The Rivermead post concussion symptoms questionnaire: a confirmatory factor analysis. J Neurol 253:1603–1614CrossRefPubMed

35.

Eyres S, Carey A, Gilworth G, Neumann V, Tennant A (2005) Construct validity and reliability of the Rivermead post-concussion symptoms questionnaire. Clin Rehabil. 19:878–887CrossRefPubMed

36.

Gruskin KD, Schutzman SA (1999) Head trauma in children younger than 2 years: are there predictors for complications? Arch Pediatr Adolesc Med 153:15–20CrossRefPubMed

37.

Pietrzak M, Jagoda A, Brown L (1991) Evaluation of minor head trauma in children younger than two years. Am J Emerg Med 9:153–156CrossRefPubMed

38.

Dunning J, Batchelor J, Stratford-Smith P, Teece S, Browne J, Sharpin C et al (2004) A meta-analysis of variables that predict significant intracranial injury in minor head trauma. Arch Dis Child 89:653–659CrossRefPubMedPubMedCentral

39.

Palchak MJ, Holmes JF, Vance CW, Gelber RE, Schauer BA, Harrison MJ et al (2003) A decision rule for identifying children at low risk for brain injuries after blunt head trauma. Ann Emerg Med 42:492–506CrossRefPubMed

40.

Nigrovic LE, Schunk JE, Foerster A, Cooper A, Miskin M, Atabaki SM et al (2011) The effect of observation on cranial computed tomography utilization for children after blunt head trauma. Pediatrics 127:1067–1073CrossRefPubMed

41.

Boran BO, Boran P, Barut N, Akgun C, Celikoglu E, Bozbuga M (2006) Evaluation of mild head injury in a pediatric population. Pediatr Neurosurg 42:203–207CrossRefPubMed

42.

Barlow KM, Crawford S, Stevenson A, Sandhu SS, Belanger F, Dewey D (2010) Epidemiology of postconcussion syndrome in pediatric mild traumatic brain injury. Pediatrics 126:e374–e381CrossRefPubMed

43.

Yeates KO, Luria J, Bartkowski H, Rusin J, Martin L, Bigler ED (1999) Postconcussive symptoms in children with mild closed head injuries. J Head Trauma Rehabil. 14:337–350CrossRefPubMed

44.

Keenan HT, Bratton SL (2006) Epidemiology and outcomes of pediatric traumatic brain injury. Dev Neurosci 28:256–263CrossRefPubMed

Titel: Ambulatory or inpatient management of mild TBI in children: a post-concussion analysis
verfasst von: Danielle S. Wendling-Keim
Adriana König
Hans-Georg Dietz
Markus Lehner
Publikationsdatum: 17.11.2016
Verlag: Springer Berlin Heidelberg
Erschienen in: Pediatric Surgery International / Ausgabe 2/2017
Print ISSN: 0179-0358
Elektronische ISSN: 1437-9813
DOI: https://doi.org/10.1007/s00383-016-4021-z

Neu im Fachgebiet Pädiatrie

23.04.2024 | Typ-1-Diabetes | Nachrichten

Update Pädiatrie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Springer Medizin

Ambulatory or inpatient management of mild TBI in children: a post-concussion analysis

Abstract

Background

Methods

Results

Conclusion

Neu im Fachgebiet Pädiatrie

Neuer Typ-1-Diabetes bei Kindern am Wochenende eher übersehen

Neue Studienergebnisse zur Myopiekontrolle mit Atropin

Spinale Muskelatrophie: Neugeborenen-Screening lohnt sich

Fünf Dinge, die im Kindernotfall besser zu unterlassen sind

Update Pädiatrie

Springer Medizin

Abstract

Background

Methods

Results

Conclusion

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 2/2017

Bowel perforation after liver transplantation for biliary atresia: a retrospective study of care in the transition from children to adulthood

Duodeno-duodenostomy or duodeno-jejunostomy for duodenal atresia: is one repair better than the other?

Fundoplication with gastrostomy vs gastrostomy alone: a systematic review and meta-analysis of outcomes and complications

Dilations of anastomotic strictures over time after repair of esophageal atresia

Long-term outcomes following H-type tracheoesophageal fistula repair in infants

Advantages of abdominal ultrasound in the management of infants with necrotizing enterocolitis

Neu im Fachgebiet Pädiatrie

Neuer Typ-1-Diabetes bei Kindern am Wochenende eher übersehen

Neue Studienergebnisse zur Myopiekontrolle mit Atropin

Spinale Muskelatrophie: Neugeborenen-Screening lohnt sich

Fünf Dinge, die im Kindernotfall besser zu unterlassen sind

Update Pädiatrie