Please use this identifier to cite or link to this item:
https://hdl.handle.net/2440/121451
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Type: | Journal article |
Title: | External validation of the Scandinavian guidelines for management of minimal, mild and moderate head injuries in children |
Author: | Undén, J. Dalziel, S.R. Borland, M.L. Phillips, N. Kochar, A. Lyttle, M.D. Bressan, S. Cheek, J.A. Neutze, J. Donath, S. Hearps, S. Oakley, E. Dalton, S. Gilhotra, Y. Babl, F.E. |
Citation: | BMC Medicine, 2018; 16(1):176-1-176-10 |
Publisher: | BMC |
Issue Date: | 2018 |
ISSN: | 1741-7015 1741-7015 |
Statement of Responsibility: | Johan Undén, Stuart R. Dalziel, Meredith L. Borland, Natalie Phillips, Amit Kochar, Mark D. Lyttle ... et al. (on behalf of the Paediatric Research in Emergency Departments International Collaborative (PREDICT)) |
Abstract: | BACKGROUND:Clinical decision rules (CDRs) aid in the management of children with traumatic brain injury (TBI). Recently, the Scandinavian Neurotrauma Committee (SNC) has published practical, evidence-based guidelines for children with Glasgow Coma Scale (GCS) scores of 9-15. This study aims to validate these guidelines and to compare them with other CDRs. METHODS:A large prospective cohort of children (< 18 years) with TBI of all severities, from ten Australian and New Zealand hospitals, was used to assess the SNC guidelines. Firstly, a validation study was performed according to the inclusion and exclusion criteria of the SNC guideline. Secondly, we compared the accuracy of SNC, CATCH, CHALICE and PECARN CDRs in patients with GCS 13-15 only. Diagnostic accuracy was calculated for outcome measures of need for neurosurgery, clinically important TBI (ciTBI) and brain injury on CT. RESULTS:The SNC guideline could be applied to 19,007/20,137 of patients (94.4%) in the validation process. The frequency of ciTBI decreased significantly with stratification by decreasing risk according to the SNC guideline. Sensitivities for the detection of neurosurgery, ciTBI and brain injury on CT were 100.0% (95% CI 89.1-100.0; 32/32), 97.8% (94.5-99.4; 179/183) and 95% (95% CI 91.6-97.2; 262/276), respectively, with a CT/admission rate of 42% (mandatory CT rate of 5%, 18% CT or admission and 19% only admission). Four patients with ciTBI were missed; none needed specific intervention. In the homogenous comparison cohort of 18,913 children, the SNC guideline performed similar to the PECARN CDR, when compared with the other CDRs. CONCLUSION:The SNC guideline showed a high accuracy in a large external validation cohort and compares well with published CDRs for the management of paediatric TBI. |
Keywords: | Head trauma; head injury; guideline; clinical decision rule; infant; child; computed tomography; Scandinavia |
Rights: | © The Author(s). 2018 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
DOI: | 10.1186/s12916-018-1166-8 |
Grant ID: | http://purl.org/au-research/grants/nhmrc/1124466 http://purl.org/au-research/grants/nhmrc/1046727 http://purl.org/au-research/grants/nhmrc/1058560 |
Published version: | http://dx.doi.org/10.1186/s12916-018-1166-8 |
Appears in Collections: | Aurora harvest 4 Medicine publications |
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hdl_121451.pdf | Published version | 1.03 MB | Adobe PDF | View/Open |
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