Traumatic brain injuries and computed tomography use in pediatric sports participants

Todd Glass, Richard M. Ruddy, Elizabeth R. Alpern, Marc Gorelick, James Callahan, Lois Lee, Mike Gerardi, Kraig Melville, Michelle Miskin, James F Holmes Jr, Nathan Kuppermann

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Background Childhood sports-related head trauma is common, frequently leading to emergency department (ED) visits. We describe the spectrum of these injuries and trends in computed tomography (CT) use in the Pediatric Emergency Care Applied Research Network. Methods This was a secondary analysis of a large prospective cohort of children with head trauma in 25 Pediatric Emergency Care Applied Research Network EDs between 2004 and 2006. We described and compared children 5 to 18 years old by CT rate, traumatic brain injury (TBI) on CT, and clinically important TBI (ciTBI). We used multi-variable logistic regression to compare CT rates, adjusting for clinical severity. Outcomes included frequency of CT, TBIs on CT, and ciTBIs (defined by [a] death, [b] neurosurgery, [c] intubation > 24 hours, or [d] hospitalization for ≥ 2 nights). Findings A total of 3289 (14%) of 23 082 children had sports-related head trauma. Two percent had Glasgow Coma Scale scores less than 14. 53% received ED CTs, 4% had TBIs on CT, and 1% had ciTBIs. Equestrians had increased adjusted odds (1.8; 95% confidence interval [CI], 1.0-3.0]) of CTs; the rate of TBI on CT was 4% (95% CI, 3%-5%). Compared with team sports, snow (adjusted odds ratio, 4.1; 95% CI 1.5-11.4) and nonmotorized wheeled (adjusted odds ratio, 12.8; 95% CI, 5.5-32.4) sports had increased adjusted odds of ciTBIs. Conclusions Children with sports-related head trauma commonly undergo CT. Only 4% of those imaged had TBIs on CT. Clinically important TBIs occurred in 1%, with significant variation by sport. There is an opportunity for injury prevention efforts in high-risk sports and opportunities to reduce CT use in general by use of evidence-based prediction rules. What is known about this subject: Pediatric sports-related head injuries are a common and increasingly frequent ED presentation, as is the use of CT in their evaluation. Little is known about TBIs resulting from different types of sports activities in children. What this study adds to existing knowledge: This study broadens the understanding of the epidemiology of Pediatric TBIs resulting from different sports activities through a prospective assessment of frequency and severity of ciTBIs and ED CT use in a large cohort of head-injured children in a network of pediatric EDs.

Original languageEnglish (US)
Pages (from-to)1458-1464
Number of pages7
JournalAmerican Journal of Emergency Medicine
Volume33
Issue number10
DOIs
StatePublished - Oct 1 2015

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Sports
Tomography
Pediatrics
Craniocerebral Trauma
Hospital Emergency Service
Confidence Intervals
Emergency Medical Services
Traumatic Brain Injury
Snow Sports
Odds Ratio
Glasgow Coma Scale
Wounds and Injuries
Neurosurgery
Research
Intubation
Epidemiology
Hospitalization
Logistic Models
Head

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

Traumatic brain injuries and computed tomography use in pediatric sports participants. / Glass, Todd; Ruddy, Richard M.; Alpern, Elizabeth R.; Gorelick, Marc; Callahan, James; Lee, Lois; Gerardi, Mike; Melville, Kraig; Miskin, Michelle; Holmes Jr, James F; Kuppermann, Nathan.

In: American Journal of Emergency Medicine, Vol. 33, No. 10, 01.10.2015, p. 1458-1464.

Research output: Contribution to journalArticle

Glass, T, Ruddy, RM, Alpern, ER, Gorelick, M, Callahan, J, Lee, L, Gerardi, M, Melville, K, Miskin, M, Holmes Jr, JF & Kuppermann, N 2015, 'Traumatic brain injuries and computed tomography use in pediatric sports participants', American Journal of Emergency Medicine, vol. 33, no. 10, pp. 1458-1464. https://doi.org/10.1016/j.ajem.2015.06.069
Glass, Todd ; Ruddy, Richard M. ; Alpern, Elizabeth R. ; Gorelick, Marc ; Callahan, James ; Lee, Lois ; Gerardi, Mike ; Melville, Kraig ; Miskin, Michelle ; Holmes Jr, James F ; Kuppermann, Nathan. / Traumatic brain injuries and computed tomography use in pediatric sports participants. In: American Journal of Emergency Medicine. 2015 ; Vol. 33, No. 10. pp. 1458-1464.
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abstract = "Background Childhood sports-related head trauma is common, frequently leading to emergency department (ED) visits. We describe the spectrum of these injuries and trends in computed tomography (CT) use in the Pediatric Emergency Care Applied Research Network. Methods This was a secondary analysis of a large prospective cohort of children with head trauma in 25 Pediatric Emergency Care Applied Research Network EDs between 2004 and 2006. We described and compared children 5 to 18 years old by CT rate, traumatic brain injury (TBI) on CT, and clinically important TBI (ciTBI). We used multi-variable logistic regression to compare CT rates, adjusting for clinical severity. Outcomes included frequency of CT, TBIs on CT, and ciTBIs (defined by [a] death, [b] neurosurgery, [c] intubation > 24 hours, or [d] hospitalization for ≥ 2 nights). Findings A total of 3289 (14{\%}) of 23 082 children had sports-related head trauma. Two percent had Glasgow Coma Scale scores less than 14. 53{\%} received ED CTs, 4{\%} had TBIs on CT, and 1{\%} had ciTBIs. Equestrians had increased adjusted odds (1.8; 95{\%} confidence interval [CI], 1.0-3.0]) of CTs; the rate of TBI on CT was 4{\%} (95{\%} CI, 3{\%}-5{\%}). Compared with team sports, snow (adjusted odds ratio, 4.1; 95{\%} CI 1.5-11.4) and nonmotorized wheeled (adjusted odds ratio, 12.8; 95{\%} CI, 5.5-32.4) sports had increased adjusted odds of ciTBIs. Conclusions Children with sports-related head trauma commonly undergo CT. Only 4{\%} of those imaged had TBIs on CT. Clinically important TBIs occurred in 1{\%}, with significant variation by sport. There is an opportunity for injury prevention efforts in high-risk sports and opportunities to reduce CT use in general by use of evidence-based prediction rules. What is known about this subject: Pediatric sports-related head injuries are a common and increasingly frequent ED presentation, as is the use of CT in their evaluation. Little is known about TBIs resulting from different types of sports activities in children. What this study adds to existing knowledge: This study broadens the understanding of the epidemiology of Pediatric TBIs resulting from different sports activities through a prospective assessment of frequency and severity of ciTBIs and ED CT use in a large cohort of head-injured children in a network of pediatric EDs.",
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AU - Glass, Todd

AU - Ruddy, Richard M.

AU - Alpern, Elizabeth R.

AU - Gorelick, Marc

AU - Callahan, James

AU - Lee, Lois

AU - Gerardi, Mike

AU - Melville, Kraig

AU - Miskin, Michelle

AU - Holmes Jr, James F

AU - Kuppermann, Nathan

PY - 2015/10/1

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N2 - Background Childhood sports-related head trauma is common, frequently leading to emergency department (ED) visits. We describe the spectrum of these injuries and trends in computed tomography (CT) use in the Pediatric Emergency Care Applied Research Network. Methods This was a secondary analysis of a large prospective cohort of children with head trauma in 25 Pediatric Emergency Care Applied Research Network EDs between 2004 and 2006. We described and compared children 5 to 18 years old by CT rate, traumatic brain injury (TBI) on CT, and clinically important TBI (ciTBI). We used multi-variable logistic regression to compare CT rates, adjusting for clinical severity. Outcomes included frequency of CT, TBIs on CT, and ciTBIs (defined by [a] death, [b] neurosurgery, [c] intubation > 24 hours, or [d] hospitalization for ≥ 2 nights). Findings A total of 3289 (14%) of 23 082 children had sports-related head trauma. Two percent had Glasgow Coma Scale scores less than 14. 53% received ED CTs, 4% had TBIs on CT, and 1% had ciTBIs. Equestrians had increased adjusted odds (1.8; 95% confidence interval [CI], 1.0-3.0]) of CTs; the rate of TBI on CT was 4% (95% CI, 3%-5%). Compared with team sports, snow (adjusted odds ratio, 4.1; 95% CI 1.5-11.4) and nonmotorized wheeled (adjusted odds ratio, 12.8; 95% CI, 5.5-32.4) sports had increased adjusted odds of ciTBIs. Conclusions Children with sports-related head trauma commonly undergo CT. Only 4% of those imaged had TBIs on CT. Clinically important TBIs occurred in 1%, with significant variation by sport. There is an opportunity for injury prevention efforts in high-risk sports and opportunities to reduce CT use in general by use of evidence-based prediction rules. What is known about this subject: Pediatric sports-related head injuries are a common and increasingly frequent ED presentation, as is the use of CT in their evaluation. Little is known about TBIs resulting from different types of sports activities in children. What this study adds to existing knowledge: This study broadens the understanding of the epidemiology of Pediatric TBIs resulting from different sports activities through a prospective assessment of frequency and severity of ciTBIs and ED CT use in a large cohort of head-injured children in a network of pediatric EDs.

AB - Background Childhood sports-related head trauma is common, frequently leading to emergency department (ED) visits. We describe the spectrum of these injuries and trends in computed tomography (CT) use in the Pediatric Emergency Care Applied Research Network. Methods This was a secondary analysis of a large prospective cohort of children with head trauma in 25 Pediatric Emergency Care Applied Research Network EDs between 2004 and 2006. We described and compared children 5 to 18 years old by CT rate, traumatic brain injury (TBI) on CT, and clinically important TBI (ciTBI). We used multi-variable logistic regression to compare CT rates, adjusting for clinical severity. Outcomes included frequency of CT, TBIs on CT, and ciTBIs (defined by [a] death, [b] neurosurgery, [c] intubation > 24 hours, or [d] hospitalization for ≥ 2 nights). Findings A total of 3289 (14%) of 23 082 children had sports-related head trauma. Two percent had Glasgow Coma Scale scores less than 14. 53% received ED CTs, 4% had TBIs on CT, and 1% had ciTBIs. Equestrians had increased adjusted odds (1.8; 95% confidence interval [CI], 1.0-3.0]) of CTs; the rate of TBI on CT was 4% (95% CI, 3%-5%). Compared with team sports, snow (adjusted odds ratio, 4.1; 95% CI 1.5-11.4) and nonmotorized wheeled (adjusted odds ratio, 12.8; 95% CI, 5.5-32.4) sports had increased adjusted odds of ciTBIs. Conclusions Children with sports-related head trauma commonly undergo CT. Only 4% of those imaged had TBIs on CT. Clinically important TBIs occurred in 1%, with significant variation by sport. There is an opportunity for injury prevention efforts in high-risk sports and opportunities to reduce CT use in general by use of evidence-based prediction rules. What is known about this subject: Pediatric sports-related head injuries are a common and increasingly frequent ED presentation, as is the use of CT in their evaluation. Little is known about TBIs resulting from different types of sports activities in children. What this study adds to existing knowledge: This study broadens the understanding of the epidemiology of Pediatric TBIs resulting from different sports activities through a prospective assessment of frequency and severity of ciTBIs and ED CT use in a large cohort of head-injured children in a network of pediatric EDs.

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