Computed Tomography Scan Rates and Outcomes in Children Risk-Stratified Using the PREDICT Guideline Algorithm for Risk Stratification of Mild and Moderate Head Injuries

IF 1.4 4区医学 Q2 EMERGENCY MEDICINE

Emergency Medicine Australasia Pub Date : 2025-08-18 DOI:10.1111/1742-6723.70111

Stephen J. C. Hearps, Emma Tavender, Meredith L. Borland, Ed Oakley, Anneke Grobler, Vicki Anderson, Karen M. Barlow, Stuart R. Dalziel, Natalie Phillips, Amit Kochar, Sarah Dalton, Jeremy Furyk, Jocelyn Neutze, Amanda Williams, Franz E. Babl, Paediatric Research in Emergency Departments International Collaborative (PREDICT)

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引用次数: 0

Abstract

Objective

Since 2021, the PREDICT Guideline for Mild to Moderate Head Injuries in Children has been widely implemented across Australia and New Zealand. We set out to describe the application of the guideline's risk stratification using an existing database.

Methods

Secondary analysis of a large multicentre prospective data set of paediatric patients with head injuries. We stratified the sample into high, intermediate, low, and very low risk categories per the PREDICT Guideline algorithm. Rates and 95% confidence intervals (CI) of computed tomography (CT), abnormal CT, and clinically important traumatic brain injury (ciTBI) were determined within these categories.

Results

Of 20,137 patients, 1847 were excluded from risk stratification as requiring immediate CT scans (GCS ≤ 13) or as special conditions. 18,290 (90.8%) were stratified into risk categories: 542 (2.9%) high, 4843 (26.0%) intermediate, 2138 (11.5%) low, and 10,767 (57.9%) very low. CT rates were 59.2% (95% CI 55.0%–63.4%) and 18.9% (17.8%–20.1%) in high and intermediate risk groups, with subsequent abnormal CT rates of 42.1% (95% CI 36.6%–47.7%) and 17.6% (95% CI 15.1%–20.2%), and ciTBI rates of 8.9% (95% CI 6.6%–11.6%) and 1.3% (95% CI 1.0%–1.6%), respectively. CT rates were 7.1% (95% CI 6.1%–8.3%) and 1.8% (95% CI 1.6%–2.1%) for low and very low risk groups, with ciTBI rates of 0.4% (95% CI 0.2%–0.8%) and 0.01% (95% CI 0.0002%–0.1%). 9 low and 1 very low risk patient had a ciTBI (2 required neurosurgery).

Conclusions

The PREDICT Guideline algorithm risk stratifies head injuries into high, intermediate, low, and very low risk patients. Two of the missed lower risk patients required neurosurgery.

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使用预测指南算法对轻度和中度头部损伤进行风险分层的儿童计算机断层扫描率和结果

自2021年以来，澳大利亚和新西兰广泛实施了《儿童轻中度头部损伤预测指南》。我们开始使用现有的数据库来描述指南的风险分层的应用。方法对大型多中心前瞻性儿科颅脑损伤患者资料进行二次分析。我们根据PREDICT指南算法将样本分为高、中、低和极低风险类别。在这些分类中确定计算机断层扫描（CT）、异常CT和临床重要创伤性脑损伤（ciTBI）的发生率和95%置信区间（CI）。结果20137例患者中，1847例因需要立即CT扫描（GCS≤13）或有特殊情况而被排除在危险分层之外。其中高风险542例（2.9%），中等风险4843例（26.0%），低风险2138例（11.5%），极低风险10767例（57.9%）。高、中危组CT异常率分别为59.2% （95% CI 55.0% ~ 63.4%）和18.9%(17.8% ~ 20.1%)，随后CT异常率分别为42.1% （95% CI 36.6% ~ 47.7%）和17.6% (95% CI 15.1% ~ 20.2%)， ciTBI异常率分别为8.9% （95% CI 6.6% ~ 11.6%）和1.3% （95% CI 1.0% ~ 1.6%）。低风险组和极低风险组的CT率分别为7.1% （95% CI 6.1%-8.3%）和1.8% (95% CI 1.6%-2.1%)， ciTBI率分别为0.4% （95% CI 0.2%-0.8%）和0.01% （95% CI 0.0002%-0.1%）。9例低危和1例极低危患者发生了ciTBI（2例需要神经外科手术）。PREDICT指南算法将颅脑损伤风险分为高、中、低和极低风险患者。两名漏诊的低危患者需要进行神经外科手术。

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来源期刊

Emergency Medicine Australasia 医学-急救医学

CiteScore

3.70

自引率

13.00%

发文量

217

审稿时长

6-12 weeks

期刊介绍： Emergency Medicine Australasia is the official journal of the Australasian College for Emergency Medicine (ACEM) and the Australasian Society for Emergency Medicine (ASEM), and publishes original articles dealing with all aspects of clinical practice, research, education and experiences in emergency medicine. Original articles are published under the following sections: Original Research, Paediatric Emergency Medicine, Disaster Medicine, Education and Training, Ethics, International Emergency Medicine, Management and Quality, Medicolegal Matters, Prehospital Care, Public Health, Rural and Remote Care, Technology, Toxicology and Trauma. Accepted papers become the copyright of the journal.