Thursday, July 30, 2015

Sports traumatic brain injury and CT

Todd Glass, Richard M. Ruddy, Elizabeth R. Alpern, Marc Gorelick, James Callahan, Lois Lee, Mike Gerardi,  Kraig Melville MD, Michelle Miskin, James F. Holmes, Nathan Kuppermann.  Traumatic Brain Injuries and Computed Tomography Use in Pediatric Sports Participants.  American Journal of Emergency Medicine.  Published online 6 July 2015.
Childhood sports-related head trauma is common, frequently leading to emergency department (ED) visits. We describe the spectrum of these injuries and trends in computed tomography (CT) use in the Pediatric Emergency Care Applied Research Network (PECARN).
This was a secondary analysis of a large prospective cohort of children with head trauma in 25 PECARN EDs between 2004–6. We described and compared children 5–18 years by CT rate, TBI on CT and clinically-important TBI (ciTBI). We used multivariable logistic regression to compare CT rates, adjusting for clinical severity. Outcomes included frequency of CT, TBIs on CT, and ciTBIs (defined by a) death, b) neurosurgery, c) intubation >24 hours, or d) hospitalization for ≥2 nights).
3,289 / 23,082 (14%) children had sports-related head trauma. 2% had Glasgow Coma Scale scores <14. 53% received ED CTs, 4% had TBIs on CT, and 1% had ciTBIs. Equestrians had increased adjusted odds [1.8 (95% CI 1.0, 3.0)] of CTs; the rate of TBI on CT was 4% (95% CI 3, 5%). Compared to team sports, snow [AOR 4.1 (95% CI 1.5, 11.4)] and non-motorized wheeled [AOR 12.8 (95% CI 5.5, 32.4)] sports had increased adjusted odds of ciTBIs.
Children with sports-related head trauma commonly undergo CT. Only 4% of those imaged had TBIs on CT. ciTBIs occurred in 1%, with significant variation by sport. There is an opportunity for injury prevention efforts in high-risk sports and opportunities to reduce CT use in general by use of evidence-based prediction rules.
What is known about this subject – Pediatric sports-related head injuries are a common and increasingly frequent emergency department (ED) presentation, as is the use of computed tomography (CT) in their evaluation. Little is known about traumatic brain injuries (TBIs) resulting from different types of sports activities in children.
What this study adds to existing knowledge – This study broadens the understanding of the epidemiology of pediatric TBIs resulting from different sports activities through a prospective assessment of frequency and severity of clinically-important TBIs, and ED CT use in a large cohort of head-injured children in a network of pediatric EDs.

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