Does an isolated history of loss of consciousness or amnesia predict brain injuries in children after blunt head trauma?

Michael J. Palchak, James F Holmes Jr, Cheryl Vance, Rebecca E. Gelber, Bobbie A. Schauer, Mathew J. Harrison, Jason Willis-Shore, Sandra L. Wootton-Gorges, Robert W. Derlet, Nathan Kuppermann

Research output: Contribution to journalArticle

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Abstract

BACKGROUND: A history of loss of consciousness (LOC) is frequently used as an indication for cranial computed tomography (CT) in the emergency department (ED) evaluation of children with blunt head trauma. OBJECTIVE: We sought to determine whether an isolated LOC and/or amnesia is predictive of traumatic brain injury (TBI) in children with blunt head trauma. METHODS: We prospectively enrolled children <18 years old presenting to a level I trauma center ED between July 1998 and September 2001 with blunt head trauma. We evaluated the association of LOC and/or amnesia with 1) TBI identified on CT and 2) TBI requiring acute intervention. We defined the latter by a neurosurgical procedure, antiepileptic medication for >1 week, persistent neurologic deficits, or hospitalization for > or =2 nights. We then investigated the association of LOC and/or amnesia with TBI in those patients without other symptoms or signs of TBI ("isolated" LOC and/or amnesia). RESULTS: Of eligible children, 2043 (77%) were enrolled, 1271 (62%) of whom underwent CT; 1159 (91%) of these 1271 had their LOC and/or amnesia status known. A total of 801 (39%) of the 2043 enrolled children had a documented history of LOC and/or amnesia. Of the 745 with documented LOC and/or amnesia who underwent CT, 70 (9.4%; 95% confidence interval [CI]: 7.4%, 11.7%) had TBI identified on CT versus 11 of 414 (2.7%; 95% CI: 1.3%, 4.7%) without LOC and/or amnesia (difference: 6.7%; 95% CI: 4.1%, 9.3%). Of the 801 children known to have had LOC and/or amnesia (regardless of whether they underwent CT), 77 (9.6%; 95% CI: 7.7%, 11.9%) had TBI requiring acute intervention versus 11 of 1115 (1%; 95% CI: 0.5%, 1.8%) of those without LOC and/or amnesia (difference: 8.6%; 95% CI: 6.5%, 10.7%). For those with an isolated LOC and/or amnesia without other signs or symptoms of TBI, however, 0 of 142 (95% CI: 0%, 2.1%) had TBI identified on CT, and 0 of 164 (95% CI: 0%,1.8%) had TBI requiring acute intervention. CONCLUSIONS: Isolated LOC and/or amnesia, defined by the absence of other clinical findings suggestive of TBI, are not predictive of either TBI on CT or TBI requiring acute intervention. Elimination of an isolated LOC and/or amnesia as an indication for CT may decrease unnecessary CT use in those patients without an appreciable risk of TBI.

Original languageEnglish (US)
JournalPediatrics
Volume113
Issue number6
StatePublished - Jun 2004

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Amnesia
Unconsciousness
Craniocerebral Trauma
Brain Injuries
Tomography
Confidence Intervals
Signs and Symptoms
Traumatic Brain Injury
Neurologic Manifestations
Hospital Emergency Service
Hospitalization

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

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Does an isolated history of loss of consciousness or amnesia predict brain injuries in children after blunt head trauma? / Palchak, Michael J.; Holmes Jr, James F; Vance, Cheryl; Gelber, Rebecca E.; Schauer, Bobbie A.; Harrison, Mathew J.; Willis-Shore, Jason; Wootton-Gorges, Sandra L.; Derlet, Robert W.; Kuppermann, Nathan.

In: Pediatrics, Vol. 113, No. 6, 06.2004.

Research output: Contribution to journalArticle

Palchak, MJ, Holmes Jr, JF, Vance, C, Gelber, RE, Schauer, BA, Harrison, MJ, Willis-Shore, J, Wootton-Gorges, SL, Derlet, RW & Kuppermann, N 2004, 'Does an isolated history of loss of consciousness or amnesia predict brain injuries in children after blunt head trauma?', Pediatrics, vol. 113, no. 6.
Palchak, Michael J. ; Holmes Jr, James F ; Vance, Cheryl ; Gelber, Rebecca E. ; Schauer, Bobbie A. ; Harrison, Mathew J. ; Willis-Shore, Jason ; Wootton-Gorges, Sandra L. ; Derlet, Robert W. ; Kuppermann, Nathan. / Does an isolated history of loss of consciousness or amnesia predict brain injuries in children after blunt head trauma?. In: Pediatrics. 2004 ; Vol. 113, No. 6.
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title = "Does an isolated history of loss of consciousness or amnesia predict brain injuries in children after blunt head trauma?",
abstract = "BACKGROUND: A history of loss of consciousness (LOC) is frequently used as an indication for cranial computed tomography (CT) in the emergency department (ED) evaluation of children with blunt head trauma. OBJECTIVE: We sought to determine whether an isolated LOC and/or amnesia is predictive of traumatic brain injury (TBI) in children with blunt head trauma. METHODS: We prospectively enrolled children <18 years old presenting to a level I trauma center ED between July 1998 and September 2001 with blunt head trauma. We evaluated the association of LOC and/or amnesia with 1) TBI identified on CT and 2) TBI requiring acute intervention. We defined the latter by a neurosurgical procedure, antiepileptic medication for >1 week, persistent neurologic deficits, or hospitalization for > or =2 nights. We then investigated the association of LOC and/or amnesia with TBI in those patients without other symptoms or signs of TBI ({"}isolated{"} LOC and/or amnesia). RESULTS: Of eligible children, 2043 (77{\%}) were enrolled, 1271 (62{\%}) of whom underwent CT; 1159 (91{\%}) of these 1271 had their LOC and/or amnesia status known. A total of 801 (39{\%}) of the 2043 enrolled children had a documented history of LOC and/or amnesia. Of the 745 with documented LOC and/or amnesia who underwent CT, 70 (9.4{\%}; 95{\%} confidence interval [CI]: 7.4{\%}, 11.7{\%}) had TBI identified on CT versus 11 of 414 (2.7{\%}; 95{\%} CI: 1.3{\%}, 4.7{\%}) without LOC and/or amnesia (difference: 6.7{\%}; 95{\%} CI: 4.1{\%}, 9.3{\%}). Of the 801 children known to have had LOC and/or amnesia (regardless of whether they underwent CT), 77 (9.6{\%}; 95{\%} CI: 7.7{\%}, 11.9{\%}) had TBI requiring acute intervention versus 11 of 1115 (1{\%}; 95{\%} CI: 0.5{\%}, 1.8{\%}) of those without LOC and/or amnesia (difference: 8.6{\%}; 95{\%} CI: 6.5{\%}, 10.7{\%}). For those with an isolated LOC and/or amnesia without other signs or symptoms of TBI, however, 0 of 142 (95{\%} CI: 0{\%}, 2.1{\%}) had TBI identified on CT, and 0 of 164 (95{\%} CI: 0{\%},1.8{\%}) had TBI requiring acute intervention. CONCLUSIONS: Isolated LOC and/or amnesia, defined by the absence of other clinical findings suggestive of TBI, are not predictive of either TBI on CT or TBI requiring acute intervention. Elimination of an isolated LOC and/or amnesia as an indication for CT may decrease unnecessary CT use in those patients without an appreciable risk of TBI.",
author = "Palchak, {Michael J.} and {Holmes Jr}, {James F} and Cheryl Vance and Gelber, {Rebecca E.} and Schauer, {Bobbie A.} and Harrison, {Mathew J.} and Jason Willis-Shore and Wootton-Gorges, {Sandra L.} and Derlet, {Robert W.} and Nathan Kuppermann",
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language = "English (US)",
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journal = "Pediatrics",
issn = "0031-4005",
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TY - JOUR

T1 - Does an isolated history of loss of consciousness or amnesia predict brain injuries in children after blunt head trauma?

AU - Palchak, Michael J.

AU - Holmes Jr, James F

AU - Vance, Cheryl

AU - Gelber, Rebecca E.

AU - Schauer, Bobbie A.

AU - Harrison, Mathew J.

AU - Willis-Shore, Jason

AU - Wootton-Gorges, Sandra L.

AU - Derlet, Robert W.

AU - Kuppermann, Nathan

PY - 2004/6

Y1 - 2004/6

N2 - BACKGROUND: A history of loss of consciousness (LOC) is frequently used as an indication for cranial computed tomography (CT) in the emergency department (ED) evaluation of children with blunt head trauma. OBJECTIVE: We sought to determine whether an isolated LOC and/or amnesia is predictive of traumatic brain injury (TBI) in children with blunt head trauma. METHODS: We prospectively enrolled children <18 years old presenting to a level I trauma center ED between July 1998 and September 2001 with blunt head trauma. We evaluated the association of LOC and/or amnesia with 1) TBI identified on CT and 2) TBI requiring acute intervention. We defined the latter by a neurosurgical procedure, antiepileptic medication for >1 week, persistent neurologic deficits, or hospitalization for > or =2 nights. We then investigated the association of LOC and/or amnesia with TBI in those patients without other symptoms or signs of TBI ("isolated" LOC and/or amnesia). RESULTS: Of eligible children, 2043 (77%) were enrolled, 1271 (62%) of whom underwent CT; 1159 (91%) of these 1271 had their LOC and/or amnesia status known. A total of 801 (39%) of the 2043 enrolled children had a documented history of LOC and/or amnesia. Of the 745 with documented LOC and/or amnesia who underwent CT, 70 (9.4%; 95% confidence interval [CI]: 7.4%, 11.7%) had TBI identified on CT versus 11 of 414 (2.7%; 95% CI: 1.3%, 4.7%) without LOC and/or amnesia (difference: 6.7%; 95% CI: 4.1%, 9.3%). Of the 801 children known to have had LOC and/or amnesia (regardless of whether they underwent CT), 77 (9.6%; 95% CI: 7.7%, 11.9%) had TBI requiring acute intervention versus 11 of 1115 (1%; 95% CI: 0.5%, 1.8%) of those without LOC and/or amnesia (difference: 8.6%; 95% CI: 6.5%, 10.7%). For those with an isolated LOC and/or amnesia without other signs or symptoms of TBI, however, 0 of 142 (95% CI: 0%, 2.1%) had TBI identified on CT, and 0 of 164 (95% CI: 0%,1.8%) had TBI requiring acute intervention. CONCLUSIONS: Isolated LOC and/or amnesia, defined by the absence of other clinical findings suggestive of TBI, are not predictive of either TBI on CT or TBI requiring acute intervention. Elimination of an isolated LOC and/or amnesia as an indication for CT may decrease unnecessary CT use in those patients without an appreciable risk of TBI.

AB - BACKGROUND: A history of loss of consciousness (LOC) is frequently used as an indication for cranial computed tomography (CT) in the emergency department (ED) evaluation of children with blunt head trauma. OBJECTIVE: We sought to determine whether an isolated LOC and/or amnesia is predictive of traumatic brain injury (TBI) in children with blunt head trauma. METHODS: We prospectively enrolled children <18 years old presenting to a level I trauma center ED between July 1998 and September 2001 with blunt head trauma. We evaluated the association of LOC and/or amnesia with 1) TBI identified on CT and 2) TBI requiring acute intervention. We defined the latter by a neurosurgical procedure, antiepileptic medication for >1 week, persistent neurologic deficits, or hospitalization for > or =2 nights. We then investigated the association of LOC and/or amnesia with TBI in those patients without other symptoms or signs of TBI ("isolated" LOC and/or amnesia). RESULTS: Of eligible children, 2043 (77%) were enrolled, 1271 (62%) of whom underwent CT; 1159 (91%) of these 1271 had their LOC and/or amnesia status known. A total of 801 (39%) of the 2043 enrolled children had a documented history of LOC and/or amnesia. Of the 745 with documented LOC and/or amnesia who underwent CT, 70 (9.4%; 95% confidence interval [CI]: 7.4%, 11.7%) had TBI identified on CT versus 11 of 414 (2.7%; 95% CI: 1.3%, 4.7%) without LOC and/or amnesia (difference: 6.7%; 95% CI: 4.1%, 9.3%). Of the 801 children known to have had LOC and/or amnesia (regardless of whether they underwent CT), 77 (9.6%; 95% CI: 7.7%, 11.9%) had TBI requiring acute intervention versus 11 of 1115 (1%; 95% CI: 0.5%, 1.8%) of those without LOC and/or amnesia (difference: 8.6%; 95% CI: 6.5%, 10.7%). For those with an isolated LOC and/or amnesia without other signs or symptoms of TBI, however, 0 of 142 (95% CI: 0%, 2.1%) had TBI identified on CT, and 0 of 164 (95% CI: 0%,1.8%) had TBI requiring acute intervention. CONCLUSIONS: Isolated LOC and/or amnesia, defined by the absence of other clinical findings suggestive of TBI, are not predictive of either TBI on CT or TBI requiring acute intervention. Elimination of an isolated LOC and/or amnesia as an indication for CT may decrease unnecessary CT use in those patients without an appreciable risk of TBI.

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