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External validation of the Scandinavian guidelines for management of minimal, mild and moderate head injuries in children

Und�n, Johan; Dalziel, Stuart R.; Borland, Meredith L.; Phillips, Natalie; Kochar, Amit; Lyttle, Mark D.; Bressan, Silvia; Cheek, John A.; Neutze, Jocelyn; Donath, Susan; Hearps, Stephen; Oakley, Ed; Dalton, Sarah; Gilhotra, Yuri; Babl, Franz E.

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Authors

Johan Und�n

Stuart R. Dalziel

Meredith L. Borland

Natalie Phillips

Amit Kochar

Silvia Bressan

John A. Cheek

Jocelyn Neutze

Susan Donath

Stephen Hearps

Ed Oakley

Sarah Dalton

Yuri Gilhotra

Franz E. Babl



Abstract

© 2018 The Author(s). 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.

Citation

Undén, J., Dalziel, S. R., Borland, M. L., Phillips, N., Kochar, A., Lyttle, M. D., …Babl, F. E. (2018). External validation of the Scandinavian guidelines for management of minimal, mild and moderate head injuries in children. BMC Medicine, 16(1), https://doi.org/10.1186/s12916-018-1166-8

Journal Article Type Article
Acceptance Date Sep 7, 2018
Publication Date Oct 12, 2018
Deposit Date Oct 23, 2018
Publicly Available Date Mar 28, 2024
Journal BMC Medicine
Electronic ISSN 1741-7015
Publisher BioMed Central
Peer Reviewed Peer Reviewed
Volume 16
Issue 1
DOI https://doi.org/10.1186/s12916-018-1166-8
Keywords paediatric, head injury, clinical decision rule
Public URL https://uwe-repository.worktribe.com/output/858955
Publisher URL http://dx.doi.org/10.1186/s12916-018-1166-8