Derivation of the children's head injury algorithm for the prediction of important clinical events decision rule for head injury in children

被引:340
作者
Dunning, J.
Daly, J. Patrick
Lomas, J-P
Lecky, F.
Batchelor, J.
Mackway-Jones, K.
机构
[1] Manchester Royal Infirm, Emergency Dept, Emergency Med Res Grp, Manchester M13 9WL, Lancs, England
[2] Univ Manchester, Manchester, Lancs, England
[3] Hope Hosp, Emergency Dept, Manchester, Lancs, England
关键词
D O I
10.1136/adc.2005.083980
中图分类号
R72 [儿科学];
学科分类号
100202 ;
摘要
Background: A quarter of all patients presenting to emergency departments are children. Although there are several large, well-conducted studies on adults enabling accurate selection of patients with head injury at high risk for computed tomography scanning, no such study has derived a rule for children. Aim: To conduct a prospective multicentre diagnostic cohort study to provide a rule for selection of high-risk children with head injury for computed tomography scanning. Design: All children presenting to the emergency departments of 10 hospitals in the northwest of England with any severity of head injury were recruited. A tailor-made proforma was used to collect data on around 40 clinical variables for each child. These variables were defined from a literature review, and a pilot study was conducted before the children's head injury algorithm for the prediction of important clinical events (CHALICE) study. All children who had a clinically significant head injury (death, need for neurosurgical intervention or abnormality on a computed tomography scan) were identified. Recursive partitioning was used to create a highly sensitive rule for the prediction of significant intracranial pathology. Results: 22 772 children were recruited over 21/2 years. 65% of these were boys and 56% were < 5 years old. 281 children showed an abnormality on the computed tomography scan, 137 had a neurosurgical operation and 15 died. The CHALICE rule was derived with a sensitivity of 98% (95% confidence interval (CI) 96% to 100%) and a specificity of 87% (95% CI 86% to 87%) for the prediction of clinically significant head injury, and requires a computed tomography scan rate of 14%. Conclusion: A highly sensitive clinical decision rule is derived for the identification of children who should undergo computed tomography scanning after head injury. This rule has the potential to improve and standardise the care of children presenting with head injuries. Validation of this rule in new cohorts of patients should now be undertaken.
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页码:885 / 891
页数:7
相关论文
共 33 条
[1]  
[Anonymous], REP WORK PART MAN PA
[2]  
Bergman DA, 1999, PEDIATRICS, V104, P1407
[3]   PREDICTORS OF INTRACRANIAL INJURY IN PATIENTS WITH MILD HEAD TRAUMA [J].
BORCZUK, P .
ANNALS OF EMERGENCY MEDICINE, 1995, 25 (06) :731-736
[4]   HEAD-INJURIES IN ACCIDENT AND EMERGENCY DEPARTMENTS - HOW DIFFERENT ARE CHILDREN FROM ADULTS [J].
BROOKES, M ;
MACMILLAN, R ;
CULLY, S ;
ANDERSON, E ;
MURRAY, S ;
MENDELOW, AD ;
JENNETT, B .
JOURNAL OF EPIDEMIOLOGY AND COMMUNITY HEALTH, 1990, 44 (02) :147-151
[6]   A COEFFICIENT OF AGREEMENT FOR NOMINAL SCALES [J].
COHEN, J .
EDUCATIONAL AND PSYCHOLOGICAL MEASUREMENT, 1960, 20 (01) :37-46
[7]   The implications of NICE guidelines on the management of children presenting with head injury [J].
Dunning, J ;
Daly, JP ;
Malhotra, R ;
Stratford-Smith, P ;
Lomas, JP ;
Lecky, F ;
Batchelor, J ;
Mackway-Jones, K .
ARCHIVES OF DISEASE IN CHILDHOOD, 2004, 89 (08) :763-767
[8]   A meta-analysis of variables that predict significant intracranial injury in minor head trauma [J].
Dunning, J ;
Batchelor, J ;
Stratford-Smith, P ;
Teece, S ;
Browne, J ;
Sharpin, C ;
Mackway-Jones, K .
ARCHIVES OF DISEASE IN CHILDHOOD, 2004, 89 (07) :653-659
[9]   Clinical indicators of intracranial injury in head-injured infants [J].
Greenes, DS ;
Schutzman, SA .
PEDIATRICS, 1999, 104 (04) :861-867
[10]   Indications for computed tomography in patients with minor head injury. [J].
Haydel, MJ ;
Preston, CA ;
Mills, TJ ;
Luber, S ;
Blaudeau, E ;
DeBlieux, PMC .
NEW ENGLAND JOURNAL OF MEDICINE, 2000, 343 (02) :100-105