Intracranial hemorrhage after blunt head trauma in children with bleeding disorders

Lois K. Lee, Peter S. Dayan, Michael J. Gerardi, Dominic A. Borgialli, Mohamed K. Badawy, James M. Callahan, Kathleen A. Lillis, Rachel M. Stanley, Marc H. Gorelick, Li Dong, Sally Jo Zuspan, James F Holmes Jr, Nathan Kuppermann

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

Objective: To determine computerized tomography (CT) use and prevalence of traumatic intracranial hemorrhage (ICH) in children with and without congenital and acquired bleeding disorders. Study design: We compared CT use and ICH prevalence in children with and without bleeding disorders in a multicenter cohort study of 43 904 children <18 years old with blunt head trauma evaluated in 25 emergency departments. Results: A total of 230 children had bleeding disorders; all had Glasgow Coma Scale (GCS) scores of 14 to 15. These children had higher CT rates than children without bleeding disorders and GCS scores of 14 to 15 (risk ratio, 2.29; 95% CI, 2.15 to 2.44). Of the children who underwent imaging with CT, 2 of 186 children with bleeding disorders had ICH (1.1%; 95% CI, 0.1 to 3.8), compared with 655 of 14 969 children without bleeding disorders (4.4%; 95% CI, 4.1-4.7; rate ratio, 0.25; 95% CI, 0.06 to 0.98). Both children with bleeding disorders and ICHs had symptoms; none of the children required neurosurgery. Conclusion: In children with head trauma, CTs are obtained twice as often in children with bleeding disorders, although ICHs occurred in only 1.1%, and these patients had symptoms. Routine CT imaging after head trauma may not be required in children without symptoms who have congenital and acquired bleeding disorders.

Original languageEnglish (US)
JournalJournal of Pediatrics
Volume158
Issue number6
DOIs
StatePublished - Jun 2011

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Intracranial Hemorrhages
Craniocerebral Trauma
Hemorrhage
Tomography
Glasgow Coma Scale
Traumatic Intracranial Hemorrhage
Neurosurgery
Multicenter Studies
Hospital Emergency Service

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Intracranial hemorrhage after blunt head trauma in children with bleeding disorders. / Lee, Lois K.; Dayan, Peter S.; Gerardi, Michael J.; Borgialli, Dominic A.; Badawy, Mohamed K.; Callahan, James M.; Lillis, Kathleen A.; Stanley, Rachel M.; Gorelick, Marc H.; Dong, Li; Zuspan, Sally Jo; Holmes Jr, James F; Kuppermann, Nathan.

In: Journal of Pediatrics, Vol. 158, No. 6, 06.2011.

Research output: Contribution to journalArticle

Lee, LK, Dayan, PS, Gerardi, MJ, Borgialli, DA, Badawy, MK, Callahan, JM, Lillis, KA, Stanley, RM, Gorelick, MH, Dong, L, Zuspan, SJ, Holmes Jr, JF & Kuppermann, N 2011, 'Intracranial hemorrhage after blunt head trauma in children with bleeding disorders', Journal of Pediatrics, vol. 158, no. 6. https://doi.org/10.1016/j.jpeds.2010.11.036
Lee, Lois K. ; Dayan, Peter S. ; Gerardi, Michael J. ; Borgialli, Dominic A. ; Badawy, Mohamed K. ; Callahan, James M. ; Lillis, Kathleen A. ; Stanley, Rachel M. ; Gorelick, Marc H. ; Dong, Li ; Zuspan, Sally Jo ; Holmes Jr, James F ; Kuppermann, Nathan. / Intracranial hemorrhage after blunt head trauma in children with bleeding disorders. In: Journal of Pediatrics. 2011 ; Vol. 158, No. 6.
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abstract = "Objective: To determine computerized tomography (CT) use and prevalence of traumatic intracranial hemorrhage (ICH) in children with and without congenital and acquired bleeding disorders. Study design: We compared CT use and ICH prevalence in children with and without bleeding disorders in a multicenter cohort study of 43 904 children <18 years old with blunt head trauma evaluated in 25 emergency departments. Results: A total of 230 children had bleeding disorders; all had Glasgow Coma Scale (GCS) scores of 14 to 15. These children had higher CT rates than children without bleeding disorders and GCS scores of 14 to 15 (risk ratio, 2.29; 95{\%} CI, 2.15 to 2.44). Of the children who underwent imaging with CT, 2 of 186 children with bleeding disorders had ICH (1.1{\%}; 95{\%} CI, 0.1 to 3.8), compared with 655 of 14 969 children without bleeding disorders (4.4{\%}; 95{\%} CI, 4.1-4.7; rate ratio, 0.25; 95{\%} CI, 0.06 to 0.98). Both children with bleeding disorders and ICHs had symptoms; none of the children required neurosurgery. Conclusion: In children with head trauma, CTs are obtained twice as often in children with bleeding disorders, although ICHs occurred in only 1.1{\%}, and these patients had symptoms. Routine CT imaging after head trauma may not be required in children without symptoms who have congenital and acquired bleeding disorders.",
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AU - Gerardi, Michael J.

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AU - Badawy, Mohamed K.

AU - Callahan, James M.

AU - Lillis, Kathleen A.

AU - Stanley, Rachel M.

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AU - Holmes Jr, James F

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N2 - Objective: To determine computerized tomography (CT) use and prevalence of traumatic intracranial hemorrhage (ICH) in children with and without congenital and acquired bleeding disorders. Study design: We compared CT use and ICH prevalence in children with and without bleeding disorders in a multicenter cohort study of 43 904 children <18 years old with blunt head trauma evaluated in 25 emergency departments. Results: A total of 230 children had bleeding disorders; all had Glasgow Coma Scale (GCS) scores of 14 to 15. These children had higher CT rates than children without bleeding disorders and GCS scores of 14 to 15 (risk ratio, 2.29; 95% CI, 2.15 to 2.44). Of the children who underwent imaging with CT, 2 of 186 children with bleeding disorders had ICH (1.1%; 95% CI, 0.1 to 3.8), compared with 655 of 14 969 children without bleeding disorders (4.4%; 95% CI, 4.1-4.7; rate ratio, 0.25; 95% CI, 0.06 to 0.98). Both children with bleeding disorders and ICHs had symptoms; none of the children required neurosurgery. Conclusion: In children with head trauma, CTs are obtained twice as often in children with bleeding disorders, although ICHs occurred in only 1.1%, and these patients had symptoms. Routine CT imaging after head trauma may not be required in children without symptoms who have congenital and acquired bleeding disorders.

AB - Objective: To determine computerized tomography (CT) use and prevalence of traumatic intracranial hemorrhage (ICH) in children with and without congenital and acquired bleeding disorders. Study design: We compared CT use and ICH prevalence in children with and without bleeding disorders in a multicenter cohort study of 43 904 children <18 years old with blunt head trauma evaluated in 25 emergency departments. Results: A total of 230 children had bleeding disorders; all had Glasgow Coma Scale (GCS) scores of 14 to 15. These children had higher CT rates than children without bleeding disorders and GCS scores of 14 to 15 (risk ratio, 2.29; 95% CI, 2.15 to 2.44). Of the children who underwent imaging with CT, 2 of 186 children with bleeding disorders had ICH (1.1%; 95% CI, 0.1 to 3.8), compared with 655 of 14 969 children without bleeding disorders (4.4%; 95% CI, 4.1-4.7; rate ratio, 0.25; 95% CI, 0.06 to 0.98). Both children with bleeding disorders and ICHs had symptoms; none of the children required neurosurgery. Conclusion: In children with head trauma, CTs are obtained twice as often in children with bleeding disorders, although ICHs occurred in only 1.1%, and these patients had symptoms. Routine CT imaging after head trauma may not be required in children without symptoms who have congenital and acquired bleeding disorders.

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