Mild traumatic brain injury in children with ventricular shunts: a PREDICT study

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  • 1 Emergency Department, Royal Children’s Hospital, Melbourne;
  • 2 Murdoch Children’s Research Institute, Melbourne, Victoria, Australia;
  • 3 Emergency Department, Bristol Royal Hospital for Children, Bristol;
  • 4 Faculty of Health and Life Sciences, University of the West of England, Bristol, United Kingdom;
  • 5 Emergency Department, Perth Children’s Hospital;
  • 6 School of Medicine, Divisions of Emergency Medicine and Paediatrics, University of Western Australia, Perth;
  • 7 Emergency Department, Queensland Children’s Hospital, and Child Health Research Centre, Faculty of Medicine, The University of Queensland, South Brisbane;
  • 8 Emergency Department, Women’s and Children’s Hospital, Adelaide;
  • 9 Emergency Department, The Children’s Hospital at Westmead, Sydney;
  • 10 Emergency Department, Monash Medical Centre, Melbourne;
  • 11 Emergency Department, The Townsville Hospital, Townsville;
  • 12 Emergency Department, University Hospital Geelong;
  • 13 School of Medicine, Faculty of Health, Deakin University, Geelong, Victoria, Australia;
  • 14 Emergency Department, KidzFirst Middlemore Hospital, Auckland, New Zealand;
  • 15 Department of Women’s and Children’s Health, University of Padova, Italy;
  • 16 Emergency Department, Starship Children’s Health, Auckland;
  • 17 Departments of Surgery and Paediatrics, Child and Youth Health, University of Auckland, New Zealand; and
  • 18 Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria, Australia
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OBJECTIVE

Current clinical decision rules (CDRs) guiding the use of CT scanning in pediatric traumatic brain injury (TBI) assessment generally exclude children with ventricular shunts (VSs). There is limited evidence as to the risk of abnormalities found on CT scans or clinically important TBI (ciTBI) in this population. The authors sought to determine the frequency of these outcomes and the presence of CDR predictor variables in children with VSs.

METHODS

The authors undertook a planned secondary analysis on children with VSs included in a prospective external validation of 3 CDRs for TBI in children presenting to 10 emergency departments in Australia and New Zealand. They analyzed differences in presenting features, management and acute outcomes (TBI on CT and ciTBI) between groups with and without VSs, and assessed the presence of CDR predictors in children with a VS.

RESULTS

A total of 35 of 20,137 children (0.2%) with TBI had a VS; only 2 had a Glasgow Coma Scale score < 15. Overall, 49% of patients with a VS underwent CT scanning compared with 10% of those without a VS. One patient had a finding of TBI on CT scanning, with positive predictor variables on CDRs. This patient had a ciTBI. No patient required neurosurgery. For children with and without a VS, the frequency of ciTBI was 2.9% (95% CI 0.1%–14.9%) compared with 1.4% (95% CI 1.2%–1.6%) (difference 1.5% [95% CI −4.0% to 7.0%]), and TBI on CT 2.9% (95% CI 0.1%–14.9%) compared with 2.0% (95% CI 1.8%–2.2%) (difference 0.9%, 95% CI −4.6% to 6.4%).

CONCLUSIONS

The authors’ data provide further support that the risk of TBI is similar for children with and without a VS.

ABBREVIATIONS CATCH = Canadian Assessment of Tomography for Childhood Head Injury; CDR = clinical decision rule; CHALICE = Children’s Head Injury Algorithm for the Prediction of Important Clinical Events; ciTBI = clinically important TBI; ED = emergency department; GCS = Glasgow Coma Scale; PECARN = Pediatric Emergency Care Applied Research Network; PREDICT = Paediatric Research in Emergency Departments International Collaborative; TBI = traumatic brain injury; VS = ventricular shunt.

Supplementary Materials

    • pdf Supplemental Table 1 (PDF 478 KB)

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Contributor Notes

Correspondence Franz E. Babl: University of Melbourne, Parkville, Victoria, Australia. franz.babl@rch.org.au.

INCLUDE WHEN CITING Published online November 20, 2020; DOI: 10.3171/2020.7.PEDS2090.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

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