Acute Outcomes of Isolated Pneumocephali in Children After Minor Blunt Head Trauma

Ashley Blanchard, Keven I. Cabrera, Nathan Kuppermann, Peter S. Dayan

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Abstract

OBJECTIVES: We aimed to determine the prevalence of and adverse outcomes caused by pneumocephali in children with minor blunt head trauma who had no other intracranial injuries (ie, isolated pneumocephali). METHODS: We conducted a secondary analysis of a public use dataset from a multicenter prospective study of pediatric minor head trauma. We included children younger than 18 years with Glasgow Coma Scale (GCS) scores of 14 or 15 and non-trivial mechanisms of injury who had cranial computed tomographies obtained. Patients with isolated pneumocephali were those without other traumatic brain injuries (TBIs) but could have non-depressed or basilar skull fractures (BSFs). We defined adverse outcomes as death, need for neurosurgery, or intubation more than 24 hours for TBI. RESULTS: Pneumocephali occurred in 148 (1.0%; 95% confidence interval, 0.8%–1.2%) of 14,983 patients; 54 (36.5%) of 148 were isolated. Of these 54 patients, 42 (77.8%) had associated BSFs (7 of whom also had linear skull fractures) and 8 (14.8%) had associated linear skull fractures without BSFs; 4 patients (7.4%) had no fractures. Thirty-three patients (61.1%) had both GCS scores of 15 and no other signs of altered mental status. All patients with isolated pneumocephali and available descriptive data (n = 26) had small-sized pneumocephali. There were no deaths, neurosurgical interventions, or intubations for more than 24 hours for TBI (95% confidence interval for any of the outcomes, 0%–7.9%) in the 54 patients with isolated pneumocephali. CONCLUSIONS: Children with isolated pneumocephali and GCS scores of 14 or 15 after minor blunt head trauma are unlikely to have adverse clinical outcomes.

Original languageEnglish (US)
JournalPediatric Emergency Care
DOIs
StateAccepted/In press - Oct 6 2016

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Craniocerebral Trauma
Basilar Skull Fracture
Skull Fractures
Glasgow Coma Scale
Intubation
Confidence Intervals
Wounds and Injuries
Neurosurgery
Multicenter Studies
Tomography
Prospective Studies
Pediatrics
Traumatic Brain Injury

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Emergency Medicine

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Acute Outcomes of Isolated Pneumocephali in Children After Minor Blunt Head Trauma. / Blanchard, Ashley; Cabrera, Keven I.; Kuppermann, Nathan; Dayan, Peter S.

In: Pediatric Emergency Care, 06.10.2016.

Research output: Contribution to journalArticle

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abstract = "OBJECTIVES: We aimed to determine the prevalence of and adverse outcomes caused by pneumocephali in children with minor blunt head trauma who had no other intracranial injuries (ie, isolated pneumocephali). METHODS: We conducted a secondary analysis of a public use dataset from a multicenter prospective study of pediatric minor head trauma. We included children younger than 18 years with Glasgow Coma Scale (GCS) scores of 14 or 15 and non-trivial mechanisms of injury who had cranial computed tomographies obtained. Patients with isolated pneumocephali were those without other traumatic brain injuries (TBIs) but could have non-depressed or basilar skull fractures (BSFs). We defined adverse outcomes as death, need for neurosurgery, or intubation more than 24 hours for TBI. RESULTS: Pneumocephali occurred in 148 (1.0{\%}; 95{\%} confidence interval, 0.8{\%}–1.2{\%}) of 14,983 patients; 54 (36.5{\%}) of 148 were isolated. Of these 54 patients, 42 (77.8{\%}) had associated BSFs (7 of whom also had linear skull fractures) and 8 (14.8{\%}) had associated linear skull fractures without BSFs; 4 patients (7.4{\%}) had no fractures. Thirty-three patients (61.1{\%}) had both GCS scores of 15 and no other signs of altered mental status. All patients with isolated pneumocephali and available descriptive data (n = 26) had small-sized pneumocephali. There were no deaths, neurosurgical interventions, or intubations for more than 24 hours for TBI (95{\%} confidence interval for any of the outcomes, 0{\%}–7.9{\%}) in the 54 patients with isolated pneumocephali. CONCLUSIONS: Children with isolated pneumocephali and GCS scores of 14 or 15 after minor blunt head trauma are unlikely to have adverse clinical outcomes.",
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N2 - OBJECTIVES: We aimed to determine the prevalence of and adverse outcomes caused by pneumocephali in children with minor blunt head trauma who had no other intracranial injuries (ie, isolated pneumocephali). METHODS: We conducted a secondary analysis of a public use dataset from a multicenter prospective study of pediatric minor head trauma. We included children younger than 18 years with Glasgow Coma Scale (GCS) scores of 14 or 15 and non-trivial mechanisms of injury who had cranial computed tomographies obtained. Patients with isolated pneumocephali were those without other traumatic brain injuries (TBIs) but could have non-depressed or basilar skull fractures (BSFs). We defined adverse outcomes as death, need for neurosurgery, or intubation more than 24 hours for TBI. RESULTS: Pneumocephali occurred in 148 (1.0%; 95% confidence interval, 0.8%–1.2%) of 14,983 patients; 54 (36.5%) of 148 were isolated. Of these 54 patients, 42 (77.8%) had associated BSFs (7 of whom also had linear skull fractures) and 8 (14.8%) had associated linear skull fractures without BSFs; 4 patients (7.4%) had no fractures. Thirty-three patients (61.1%) had both GCS scores of 15 and no other signs of altered mental status. All patients with isolated pneumocephali and available descriptive data (n = 26) had small-sized pneumocephali. There were no deaths, neurosurgical interventions, or intubations for more than 24 hours for TBI (95% confidence interval for any of the outcomes, 0%–7.9%) in the 54 patients with isolated pneumocephali. CONCLUSIONS: Children with isolated pneumocephali and GCS scores of 14 or 15 after minor blunt head trauma are unlikely to have adverse clinical outcomes.

AB - OBJECTIVES: We aimed to determine the prevalence of and adverse outcomes caused by pneumocephali in children with minor blunt head trauma who had no other intracranial injuries (ie, isolated pneumocephali). METHODS: We conducted a secondary analysis of a public use dataset from a multicenter prospective study of pediatric minor head trauma. We included children younger than 18 years with Glasgow Coma Scale (GCS) scores of 14 or 15 and non-trivial mechanisms of injury who had cranial computed tomographies obtained. Patients with isolated pneumocephali were those without other traumatic brain injuries (TBIs) but could have non-depressed or basilar skull fractures (BSFs). We defined adverse outcomes as death, need for neurosurgery, or intubation more than 24 hours for TBI. RESULTS: Pneumocephali occurred in 148 (1.0%; 95% confidence interval, 0.8%–1.2%) of 14,983 patients; 54 (36.5%) of 148 were isolated. Of these 54 patients, 42 (77.8%) had associated BSFs (7 of whom also had linear skull fractures) and 8 (14.8%) had associated linear skull fractures without BSFs; 4 patients (7.4%) had no fractures. Thirty-three patients (61.1%) had both GCS scores of 15 and no other signs of altered mental status. All patients with isolated pneumocephali and available descriptive data (n = 26) had small-sized pneumocephali. There were no deaths, neurosurgical interventions, or intubations for more than 24 hours for TBI (95% confidence interval for any of the outcomes, 0%–7.9%) in the 54 patients with isolated pneumocephali. CONCLUSIONS: Children with isolated pneumocephali and GCS scores of 14 or 15 after minor blunt head trauma are unlikely to have adverse clinical outcomes.

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