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Risk Factors Associated with Traumatic Brain Injury and Implementation of Guidelines for Requesting Computed Tomography After Head Trauma Among Children in France

hal.structure.identifierIMADIS
dc.contributor.authorROCHE, Stanislas
hal.structure.identifierModélisation Mathématique pour l'Oncologie [MONC]
hal.structure.identifierIMADIS
hal.structure.identifierHôpital Pellegrin
dc.contributor.authorCROMBÉ, Amandine
hal.structure.identifierHospices Civils de Lyon [HCL]
dc.contributor.authorBENHAMED, Axel
hal.structure.identifierLaboratoire d'Imagerie Interventionnelle Expérimentale [LIIE]
hal.structure.identifierCentre Européen de Recherche en Imagerie médicale [CERIMED]
hal.structure.identifierHôpital de la Timone [CHU - APHM] [TIMONE]
dc.contributor.authorHAK, Jean-François
hal.structure.identifierRadiologie pédiatrique et prénatale [Hôpital de la Timone - APHM]
dc.contributor.authorDABADIE, Alexia
hal.structure.identifierCHU Dijon
dc.contributor.authorFAUCONNIER-FATUS, Clémence
hal.structure.identifierCHU Dijon
dc.contributor.authorREGA, Adelaïde
hal.structure.identifierHôpital de la Timone [CHU - APHM] [TIMONE]
dc.contributor.authorPECH-GOURG, Grégoire
hal.structure.identifierHospices Civils de Lyon [HCL]
dc.contributor.authorTAZAROURTE, Karim
hal.structure.identifierIMADIS
dc.contributor.authorSEUX, Mylène
hal.structure.identifierCHU Dijon
dc.contributor.authorACQUIER, Adrien
hal.structure.identifierIMADIS
dc.contributor.authorGORINCOUR, Guillaume
dc.date.accessioned2024-04-04T02:30:05Z
dc.date.available2024-04-04T02:30:05Z
dc.date.issued2023-05-02
dc.identifier.urihttps://oskar-bordeaux.fr/handle/20.500.12278/190236
dc.description.abstractEnImportance Pediatric traumatic brain injuries (TBIs) are a leading cause of death and disability. The Pediatric Emergency Care Applied Research Network (PECARN) guidelines provide a framework for requesting head computed tomography (HCT) after pediatric head trauma (PHT); however, quantitative data are lacking regarding both TBIs found on HCT and justification of the HCT request according to the PECARN guidelines. Objectives To evaluate the types, frequencies, and risk factors for TBIs on HCT in children referred to emergency departments (EDs) who underwent HCT for PHT and to evaluate quality of HCT request. Design, Setting, and Participants This multicenter, retrospective cohort study included patients younger than 18 years who underwent HCT for PHT who were referred to 91 EDs during on-call hours between January 1, 2020, to May 31, 2022. Data were analyzed between July and August 2022. Exposure All radiological reports with pathologic findings were reviewed by 4 senior radiologists. Six hundred HCT requests filled by emergency physicians were randomly sampled to review the examination justification according to the PECARN guidelines. Main Outcomes and Measures Associations between TBIs, age, sex, and Glasgow Coma Scale (GCS) were investigated using univariable χ 2 and Cochrane-Armitage tests. Multivariable stepwise binary logistic regressions were used to estimate the odds ratio (ORs) for intracranial hemorrhages (ICH), any type of fracture, facial bone fracture, and skull vault fracture. Results Overall, 5146 children with HCT for PHT were included (median [IQR] age, 11.2 [4.7-15.7] years; 3245 of 5146 [63.1%] boys). ICHs were diagnosed in 306 of 5146 patients (5.9%) and fractures in 674 of 5146 patients (13.1%). The following variables were associated with ICH in multivariable analysis: GCS score of 8 or less (OR, 5.83; 95% CI, 1.97-14.60; P < .001), extracranial hematoma (OR, 2.54; 95% CI, 1.59-4.02; P < .001), skull base fracture (OR, 9.32; 95% CI, 5.03-16.97; P < .001), upper cervical fracture (OR, 19.21; 95% CI, 1.79-143.59; P = .006), and skull vault fracture (OR, 35.64; 95% CI, 24.04-53.83; P < .001). When neither extracranial hematoma nor fracture was found on HCT, the OR for presenting ICH was 0.034 (95% CI, 0.026-0.045; P < .001). Skull vault fractures were more frequently encountered in children younger than 2 years (multivariable OR, 6.31; 95% CI, 4.16-9.66; P < .001; reference: children ≥12 years), whereas facial bone fractures were more frequently encountered in boys older than 12 years (multivariable OR, 26.60; 95% CI, 9.72-109.96; P < .001; reference: children younger than 2 years). The justification for performing HCT did not follow the PECARN guidelines for 396 of 589 evaluable children (67.2%) for requests filled by emergency physicians. Conclusion and Relevance In this cohort study of 5146 children who underwent HCT for PHT, knowing the odds of clinical and radiological features for ICHs and fractures could help emergency physicians and radiologists improve their image analysis and avoid missing significant injuries. The PECARN rules were not implemented in nearly two-thirds of patients.
dc.language.isoen
dc.publisherAmerican Medical Association
dc.rights.urihttp://creativecommons.org/licenses/by/
dc.title.enRisk Factors Associated with Traumatic Brain Injury and Implementation of Guidelines for Requesting Computed Tomography After Head Trauma Among Children in France
dc.typeArticle de revue
dc.identifier.doi10.1001/jamanetworkopen.2023.11092
dc.subject.halSciences du Vivant [q-bio]/Médecine humaine et pathologie/Cardiologie et système cardiovasculaire
dc.subject.halSciences du Vivant [q-bio]/Ingénierie biomédicale/Imagerie
bordeaux.journalJAMA Network Open
bordeaux.pagee2311092
bordeaux.volume6
bordeaux.hal.laboratoriesInstitut de Mathématiques de Bordeaux (IMB) - UMR 5251*
bordeaux.issue5
bordeaux.institutionUniversité de Bordeaux
bordeaux.institutionBordeaux INP
bordeaux.institutionCNRS
bordeaux.peerReviewedoui
hal.identifierhal-04452602
hal.version1
hal.popularnon
hal.audienceInternationale
hal.origin.linkhttps://hal.archives-ouvertes.fr//hal-04452602v1
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