| 1. Taylor CA, Bell JM, Breiding MJ, Xu L. Traumatic Brain Injury-Related Emergency Department Visits, Hospitalizations, and Deaths - United States, 2007 and 2013. Morb Mortal Wkly Rep Surveill Summ. 66(9):1-16, 2017 Mar 17. |
Review/Other-Dx |
2.8 million events |
To describe the estimated incidence of Traumatic brain injury (TBI)-related emergency department (ED) visits, hospitalizations, and deaths during 2013 and makes comparisons to similar estimates from 2007. |
In 2013, a total of approximately 2.8 million TBI-related ED visits, hospitalizations, and deaths (TBI-EDHDs) occurred in the UnitedStates. This consisted of approximately 2.5 million TBI-related ED visits, approximately 282,000 TBI-related hospitalizations, and approximately 56,000 TBI-related deaths. TBIs were diagnosed in nearly 2.8 million (1.9%) of the approximately 149 million total injury- and noninjury-related EDHDs that occurred in the United States during 2013. Rates of TBI-EDHDs varied by age, with the highest rates observed among persons aged =75 years (2,232.2 per 100,000 population), 0-4 years (1,591.5), and 15-24 years (1,080.7). Overall, males had higher age-adjusted rates of TBI-EDHDs (959.0) compared with females (810.8) and the most common principal mechanisms of injury for all age groups included falls (413.2, age-adjusted), being struck by or against an object (142.1, age-adjusted), and motor-vehicle crashes (121.7, age-adjusted). The age-adjusted rate of ED visits was higher in 2013 (787.1) versus 2007 (534.4), with fall-related TBIs among persons aged =75 years accounting for 17.9% of the increase in the number of TBI-related ED visits. The number and rate of TBI-related hospitalizationsalso increased among persons aged =75 years (from 356.9 in 2007 to 454.4 in 2013), primarily because of falls. Whereas motor-vehicle crashes were the leading cause of TBI-related deaths in 2007 in both number and rate, in 2013, intentional self-harm was the leading cause in number and rate. The overall age-adjusted rate of TBI-related deaths for all ages decreased from 17.9 in 2007 to 17.0 in 2013; however, age-adjusted TBI-related death rates attributable to falls increased from 3.8 in 2007 to 4.5 in 2013, primarily among older adults. Although the age-adjusted rate of TBI-related deaths attributable to motor-vehicle crashes decreased from 5.0 in 2007 to 3.4 in 2013, the age-adjusted rate of TBI-related ED visits attributable to motor-vehicle crashes increased from 83.8 in 2007 to 99.5 in 2013. The age-adjusted rate of TBI-related hospitalizations attributable to motor-vehicle crashes decreased from 23.5 in 2007 to 18.8 in 2013 |
4 |
| 2. Pinto PS, Poretti A, Meoded A, Tekes A, Huisman TA. The unique features of traumatic brain injury in children. Review of the characteristics of the pediatric skull and brain, mechanisms of trauma, patterns of injury, complications and their imaging findings--part 1. J Neuroimaging. 2012;22(2):e1-e17. |
Review/Other-Dx |
N/A |
To discuss the unique epidemiology, mechanisms, and characteristics of traumatic head/brain injury in children, and to review the anatomical and functional imaging techniques that can be used to study common and rare pediatric traumatic brain injuries and their complications. |
CT scans are rapid and cost effective and should be utilized with a low threshold to study acute head injury, particularly in the nonaccidental trauma population. However, especially in childhood, MRI constitutes an important alternative or second line imaging modality due to its high sensitivity and specificity, better correlation with the outcome, and lack of radiation. |
4 |
| 3. Schutzman SA, Greenes DS. Pediatric minor head trauma. Ann Emerg Med. 2001;37(1):65-74. |
Review/Other-Dx |
N/A |
To review the current data and practice in assessing and treating minor head trauma in children. |
Recommendations are presented for children with acute closed head trauma who are alert or easily aroused to voice or light touch. |
4 |
| 4. Haydel MJ, Shembekar AD. Prediction of intracranial injury in children aged five years and older with loss of consciousness after minor head injury due to nontrivial mechanisms. Ann Emerg Med. 2003;42(4):507-514. |
Observational-Dx |
175 patients |
To determine whether a clinical decision rule developed for adults could be used in children aged 5 years and older. |
Throughout a 30-month period, 175 patients were enrolled, with a mean age of 12.8 years. 14 (8%) patients had ICI or depressed skull fracture on CT. The presence of any of the 6 criteria was significantly associated with an abnormal CT scan result (P<.05) and was 100% (95% CI, 73%-100%) sensitive for identifying patients with ICI. |
3 |
| 5. Kuppermann N, Holmes JF, Dayan PS, et al. Identification of children at very low risk of clinically-important brain injuries after head trauma: a prospective cohort study. Lancet. 2009;374(9696):1160-1170. |
Observational-Dx |
42,412 children |
To identify children at very low risk of clinically-important traumatic brain injuries for whom CT might be unnecessary. |
The authors obtained CT scans on 14,969 (35.3%); clinically-important TBIs occurred in 376 (0.9%), and 60 (0.1%) underwent neurosurgery. In the validation population, the prediction rule for children <2 years (normal mental status, no scalp hematoma except frontal, no loss of consciousness or loss of consciousness for less than 5 s, nonsevere injury mechanism, no palpable skull fracture, and acting normally according to the parents) had a negative predictive value for clinically-important TBI of 1176/1176 (100.0%, 95% CI, 99.7-100 0) and sensitivity of 25/25 (100%, 86.3-100.0). 167 (24.1%) of 694 CT-imaged patients <2 years were in this low-risk group. The prediction rule for children aged 2 years and older (normal mental status, no loss of consciousness, no vomiting, nonsevere injury mechanism, no signs of basilar skull fracture, and no severe headache) had a negative predictive value of 3798/3800 (99.95%, 99.81-99.99) and sensitivity of 61/63 (96.8%, 89.0-99.6). 446 (20.1%) of 2,223 CT-imaged patients aged 2 years and older were in this low-risk group. Neither rule missed neurosurgery in validation populations. |
2 |
| 6. Maguire JL, Boutis K, Uleryk EM, Laupacis A, Parkin PC. Should a head-injured child receive a head CT scan? A systematic review of clinical prediction rules. Pediatrics. 2009;124(1):e145-154. |
Review/Other-Dx |
3357 titles and abstracts assessed and 8 clinical prediction rules identified |
To systematically review the quality and performance of published clinical prediction rules for ICI in children with head injury. |
For all studies, the rule derivations were reported; no study validated a rule in a separate population or assessed its impact in actual practice. The rules differed considerably in population, predictors, outcomes, methodologic quality, and performance. Five of the rules were applicable to children of all ages and severities of trauma. Two of these were high quality (=11 of 14 quality items) and had high performance (lower confidence limits for sensitivity >0.95 and required =56% to undergo CT). 4/8 rules were applicable to children with minor head injury (GCS =13). One of these had high quality (11/14 quality items) and high performance (lower confidence limit for sensitivity = 0.94 and required 13% to undergo CT). Four of the 8 rules were applicable to young children, but none exhibited adequate quality or performance. |
4 |
| 7. Tavarez MM, Atabaki SM, Teach SJ. Acute evaluation of pediatric patients with minor traumatic brain injury. Curr Opin Pediatr. 2012;24(3):307-313. |
Review/Other-Dx |
N/A |
To evaluate the most recent literature regarding clinical prediction rules for the use of cranial CT in children presenting with minor TBI, review the evidence on the need for hospitalization in children with minor TBI, and evaluates the role of S100B testing. |
Clinical prediction rules, most notably the PECARN rules, can be applied to determine children with low-risk TBI and help decrease unnecessary CT use and hospitalizations. S100B testing requires further investigation, but may serve as an adjunct in determining children with low-risk TBI. |
4 |
| 8. Crowe L, Anderson V, Babl FE. Application of the CHALICE clinical prediction rule for intracranial injury in children outside the UK: impact on head CT rate. Arch Dis Child. 2010;95(12):1017-1022. |
Observational-Dx |
1,065 cases |
To determine the impact of children's head injury algorithm for the prediction of important clinical events (CHALICE) on the proportion of head injured patients receiving a CT scan in a major Australian pediatric emergency department. |
There were 1,091 head injuries of all severities during the study period. 18% of head injured patients had a GCS <15, 19% a CT scan and 1.4% neurosurgical intervention. Application of the CHALICE algorithm would result in 46% receiving a CT scan. 303 patients who fit CHALICE criteria did not have a CT scan. These patients were managed with admission for observation or discharge and head injury instructions. Only 5 of these (1.6% or 0.5% of total head injuries) received a CT scan on representation for ongoing symptoms, 4 of which showed abnormalities on CT scan. |
3 |
| 9. Dunning J, Daly JP, Lomas JP, Lecky F, Batchelor J, Mackway-Jones K. Derivation of the children's head injury algorithm for the prediction of important clinical events decision rule for head injury in children. Arch Dis Child. 2006;91(11):885-891. |
Observational-Dx |
22,772 patients |
To conduct a prospective multicenter diagnostic cohort study to provide a rule for selection of high-risk children with head injury for CT scanning. |
22,772 children were recruited over 2 1/2 years. 65% of these were boys and 56% were <5 years old. 281 children showed an abnormality on the CT scan, 137 had a neurosurgical operation and 15 died. The CHALICE rule was derived with a sensitivity of 98% (95% CI, 96%-100%) and a specificity of 87% (95% CI, 86%-87%) for the prediction of clinically significant head injury, and requires a CT scan rate of 14%. |
3 |
| 10. Oman JA, Cooper RJ, Holmes JF, et al. Performance of a decision rule to predict need for computed tomography among children with blunt head trauma. Pediatrics. 2006;117(2):e238-246. |
Observational-Dx |
1,666 pediatric patients |
To assess the ability of the NEXUS II head trauma decision instrument to identify patients with clinically important ICI from among children with blunt head trauma. |
NEXUS II enrolled 1,666 children, 138 (8.3%) of whom had clinically important ICI. The decision instrument correctly identified 136/138 cases and classified 230 as low-risk. A total of 309 children were younger than 3 years, among whom 25 had ICI. The decision instrument identified all 25 cases of clinically important ICI in this subgroup. |
3 |
| 11. Schachar JL, Zampolin RL, Miller TS, Farinhas JM, Freeman K, Taragin BH. External validation of the New Orleans Criteria (NOC), the Canadian CT Head Rule (CCHR) and the National Emergency X-Radiography Utilization Study II (NEXUS II) for CT scanning in pediatric patients with minor head injury in a non-trauma center. Pediatr Radiol. 2011;41(8):971-979. |
Observational-Dx |
2,101 patients |
To evaluate whether a strict application of the New Orleans Criteria (NOC), Canadian CT Head Rule (CCHR) and NEXUS II in pediatric patients with head trauma presenting to a nontrauma center (level II) could reduce the number of cranial CT scans performed without missing clinically significant ICI. |
92 (4.4%) of 2,101 patients had positive head CT findings. The sensitivities for the NOC, CCHR and NEXUS II were 96.7% (95% CI, 93.1-100), 65.2% (95% CI, 55.5-74.9) and 78.3% (95% CI, 69.9-86.7), respectively, and their negative predictive values were 98.7%, 97.6% and 97.2%, respectively. In contrast, the specificities for these aids were 11.2% (95% CI, 9.8-12.6), 64.2% (95% CI, 62.1-66.3) and 34.2% (95% CI, 32.1-36.3), respectively. Therefore, in our population it would have been possible to scan at least 10.9% fewer patients. |
3 |
| 12. Babl FE, Lyttle MD, Bressan S, et al. A prospective observational study to assess the diagnostic accuracy of clinical decision rules for children presenting to emergency departments after head injuries (protocol): the Australasian Paediatric Head Injury Rules Study (APHIRST). BMC Pediatr. 14:148, 2014 Jun 13. |
Review/Other-Dx |
20,000 patients |
To prospectively validate and compare the performance accuracy of these three clinical decision rules when applied outside the derivation setting. |
This trial is still recruiting study subjects and the results are not available yet |
4 |
| 13. Babl FE, Oakley E, Dalziel SR, et al. Accuracy of NEXUS II head injury decision rule in children: a prospective PREDICT cohort study. Emerg Med J 2019;36:4-11. |
Observational-Dx |
20,109 patients |
To externally validate The National Emergency X-Radiography Utilisation Study II (NEXUS II) clinical decision rule (CDR) in a large cohort. |
Of 20,137 total patients, we excluded 28 with suspected penetrating injury. Median age was 4.2 years. CTs were obtained in ED for 1962 (9.8%), of whom 377 (19.2%) had ICI as defined by NEXUS II. 74 (19.6% of ICI) patients underwent neurosurgery.Sensitivity for ICI based on the NEXUS II CDR was 379/383 (99.0 (95% CI 97.3% to 99.7%)) and specificity was 9320/19 726 (47.2% (95% CI 46.5% to 47.9%)) for the total cohort. Sensitivity in the CT-only cohort was similar. Of the 18 022 children without CT in ED, 49.4% had at least one NEXUS II risk criterion. Sensitivity for ICI by the clinicians without the rule was 377/377 (100.0% (95% CI 99.0% to 100.0%)) and specificity was 18 147/19 732 (92.0% (95% CI 91.6% to 92.3%)). |
3 |
| 14. Easter JS, Bakes K, Dhaliwal J, Miller M, Caruso E, Haukoos JS. Comparison of PECARN, CATCH, and CHALICE rules for children with minor head injury: a prospective cohort study. Ann Emerg Med. 64(2):145-52, 152.e1-5, 2014 Aug. |
Observational-Dx |
1009 children |
To evaluate the diagnostic accuracy of clinical decision rules and physician judgment for identifying clinically important traumatic brain injuries in children with minor head injuries presenting to the emergency department. |
Among the 1,009 children, 21 (2%; 95% confidence interval [CI] 1% to 3%) had clinically important traumatic brain injuries. Only physician practice and PECARN identified all clinically important traumatic brain injuries, with ranked sensitivities as follows: physician practice and PECARN each 100% (95% CI 84% to 100%), physician estimates 95% (95% CI 76% to 100%), CATCH 91% (95% CI 70% to 99%), and CHALICE 84% (95% CI 60% to 97%). Ranked specificities were as follows: CHALICE 85% (95% CI 82% to 87%), physician estimates 68% (95% CI 65% to 71%), PECARN 62% (95% CI 59% to 66%), physician practice 50% (95% CI 47% to 53%), and CATCH 44% (95% CI 41% to 47%). |
1 |
| 15. Lorton F, Poullaouec C, Legallais E, et al. Validation of the PECARN clinical decision rule for children with minor head trauma: a French multicenter prospective study. Scand J Trauma Resusc Emerg Med. 24:98, 2016 Aug 04. |
Observational-Dx |
1499 children |
To evaluate the diagnostic performance of the Pediatric Emergency Care Applied Research Network (PECARN) clinical decision rule in a French pediatric population in multiple clinical settings. |
During the study period, we included 1499 children of which 421 (28 %) were under 2 years of age, and 955 (64 %) were male. A cranial computed tomography (CT) scan was performed on 76 patients (5.1 %). Of the 1499 included patients, 9 children (0.6 %) had a clinically-important traumatic brain injury, and none were classified as very low risk by the PECARN rule. In our study, the sensitivity of this clinical decision rule was 100 % (95 % CI 66.4 to 100 %), the specificity was 69.9 % (95 % CI 67.5 to 72.2 %) and the negative predictive value was 100 % (95 % CI 99.7 to 100 %). |
3 |
| 16. Schonfeld D, Bressan S, Da Dalt L, Henien MN, Winnett JA, Nigrovic LE. Pediatric Emergency Care Applied Research Network head injury clinical prediction rules are reliable in practice.[Reprint of Postgrad Med J. 2015 Nov;91(1081):634-8; PMID: 26500010]. Arch Dis Child. 99(5):427-31, 2014 May. |
Observational-Dx |
2439 children |
To independently validate The Pediatric Emergency Care Applied Research Network (PECARN) traumatic brain injury (TBI) age-based clinical prediction rules |
During the study period, we included 2439 children (91% of eligible patients), of which 959 (39%) were <2 years of age and 1439 (59%) were male. Of the study patients, 373 (15%) had a CT performed, 69 (3%) had traumatic findings on their CT and 19 (0.8%) had a clinically important TBI. None of the children with aclinically important TBI were classified as very low risk by the PECARN TBI prediction rules (overall sensitivity 100%; 95% CI 83.2% to 100%, specificity 55%, 95% CI 52.5% to 56.6%, and negative predictive value 100%, 95% CI 99.6% to 100%). |
3 |
| 17. Nakhjavan-Shahraki B, Yousefifard M, Hajighanbari MJ, Oraii A, Safari S, Hosseini M. Pediatric Emergency Care Applied Research Network (PECARN) prediction rules in identifying high risk children with mild traumatic brain injury. Eur. j. trauma emerg. surg.. 43(6):755-762, 2017 Dec. |
Observational-Dx |
594 children |
To assess the value of Pediatric Emergency Care Applied Research Network (PECARN) traumatic brain injury (TBI) prognostic rule in identification of children with clinically important TBI (ciTBI). |
PECARN had a sensitivity and specificity of 92.3 and 40.6%, respectively, in predicting ciTBI in children under 2 years and 100.0 and 57.8%, respectively, in individuals between the ages of 2 and 18. PECARN rule had a proper calibration in prediction of ciTBI and CT scan findings. Brier score (overall performance) of PECARN rule in predicting ciTBI in children under 2 and 2-18 years were 1.5 and 1.2, respectively. |
3 |
| 18. Wootton-Gorges SL, Soares BP, Alazraki AL, et al. ACR Appropriateness Criteria® Suspected Physical Abuse-Child. J Am Coll Radiol 2017;14:S338-S49. |
Review/Other-Dx |
N/A |
Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for suspected physical abuse-child. |
No results stated in the abstract |
4 |
| 19. Mortazavi MM, Verma K, Tubbs RS, Harrigan M. Pediatric traumatic carotid, vertebral and cerebral artery dissections: a review. Childs Nerv Syst. 2011;27(12):2045-2056. |
Review/Other-Dx |
26 case studies from 70 pediatric patients |
Review article that highlight the fact that there is no level 1 evidence for the natural history of cerebral dissections or for the best treatment. |
No results stated in abstract. |
4 |
| 20. Stence NV, Fenton LZ, Goldenberg NA, Armstrong-Wells J, Bernard TJ. Craniocervical arterial dissection in children: diagnosis and treatment. Curr Treat Options Neurol. 2011;13(6):636-648. |
Review/Other-Dx |
N/A |
Review diagnosis and treatment of craniocervical arterial dissection in children. |
No results stated in abstract. |
4 |
| 21. How to Develop CT Protocols for Children. Available at: http://www.imagegently.org/portals/6/procedures/protocols.pdf. |
Review/Other-Dx |
N/A |
To discuss how to develop computed tomography (CT) protocols for children. |
No results stated in the abstract. |
4 |
| 22. Langford S, Panigrahy A, Narayanan S, et al. Multiplanar reconstructed CT images increased depiction of intracranial hemorrhages in pediatric head trauma. Neuroradiology. 57(12):1263-8, 2015 Dec. |
Observational-Dx |
215 cases |
To evaluate unenhanced head CTs in pediatric trauma patients to investigate the various benefits of multiplanar reconstructed images (MPR) in this age group. |
MPR improved the detection of hemorrhage in 14 cases (6.5 %, p-value < 0.01) and incidental findings in five cases (2.3 %, p-value < 0.05) as well as helped prove artifacts in five cases (2.3 %, p-value < 0.05). |
4 |
| 23. Halley MK, Silva PD, Foley J, Rodarte A. Loss of consciousness: when to perform computed tomography? Pediatr Crit Care Med. 2004;5(3):230-233. |
Observational-Dx |
98 patients |
To determine the diagnostic value of physical examination (including neurologic exam) for positive CT scan findings in children with closed head injury, GCS score 13-15 in the emergency department, and loss of consciousness or amnesia. |
CT scans revealed evidence of ICI in 13/98 subjects (13%). Normal examination increased the probability of a normal CT scan from .87 pretest to .90 post-test. 4/38 subjects with normal examination were noted to have evidence of ICI on CT. These 4 subjects did not require neurosurgical intervention. 2/98 subjects underwent neurosurgical procedures. One intracranial pressure monitor was placed for decreasing level of consciousness. One subject underwent surgical elevation of a depressed skull fracture. |
4 |
| 24. Hunter JV, Wilde EA, Tong KA, Holshouser BA. Emerging imaging tools for use with traumatic brain injury research. J Neurotrauma. 2012;29(4):654-671. |
Review/Other-Dx |
N/A |
To address some of the potential uses of more advanced forms of imaging in TBI as well as highlight some of the current considerations and unresolved challenges of using them. |
Although MRI is currently the mainstay of instrumentation for both current and emerging techniques, other technologies are also available. |
4 |
| 25. Skandsen T, Kvistad KA, Solheim O, Strand IH, Folvik M, Vik A. Prevalence and impact of diffuse axonal injury in patients with moderate and severe head injury: a cohort study of early magnetic resonance imaging findings and 1-year outcome. J Neurosurg. 2010;113(3):556-563. |
Observational-Dx |
106 patients |
To explore the occurrence of DAI and determine whether DAI was related to level of consciousness and patient outcome. |
DAI was detected in 72% of the patients and a combination of DAI and contusions or hematomas was found in 50%. The GCS was significantly lower in patients with "pure DAI" (median GCS 9) than in patients without DAI (median GCS 12; P<0.001). The GCS score was related to outcome only in those patients with DAI (r = 0.47; P=0.001). Patients with DAI had a median GOSE score of 7, and patients without DAI had a median GOSE score of 8 (P=0.10). Outcome was better in patients with DAI Stage 1 (median GOSE Score 8) and DAI Stage 2 (median GOSE Score 7.5) than in patients with DAI Stage 3 (median GOSE Score 4; P<0.001). Thus, in patients without any brainstem injury, there was no difference in good recovery between patients with DAI (67%) and patients without DAI (66%). |
2 |
| 26. Tong KA, Ashwal S, Holshouser BA, et al. Hemorrhagic shearing lesions in children and adolescents with posttraumatic diffuse axonal injury: improved detection and initial results. Radiology. 2003;227(2):332-339. |
Observational-Dx |
7 children and adolescents |
To compare the effectiveness of a high-spatial-resolution SWI MRI technique with that of a conventional gradient-recalled-echo MRI technique for detection of hemorrhage in children and adolescents with DAI. |
Hemorrhagic lesions were much more visible on SWI MRI than on conventional gradient-recalled-echo MRIs. SWI MRI depicted 1,038 hemorrhagic DAI lesions with an apparent total hemorrhage volume of 57,946 mm3. Gradient-recalled-echo MRI depicted 162 lesions with an apparent total hemorrhage volume of 28,893 mm3. SWI MRI depicted a significantly higher mean number of lesions in all patients than did gradient-recalled-echo MRI, according to results of visual (P=.004) and computer (P=.004) counting analyses. The mean hemorrhage volume load for all patients also was significantly greater (P=.014) by using SWI MRI according to computer analysis. SWI MRI appeared to depict much smaller hemorrhagic lesions than gradient-recalled-echo MRI. The majority (59%) of individual hemorrhagic DAI lesions seen on SWI MRIs were small in area (<10 mm(2)), whereas the majority (43%) of lesions seen on gradient-recalled-echo images were larger in area (10-20 mm(2)). |
3 |
| 27. Kemp AM, Rajaram S, Mann M, et al. What neuroimaging should be performed in children in whom inflicted brain injury (iBI) is suspected? A systematic review. Clin Radiol. 2009; 64(5):473-483. |
Review/Other-Dx |
18 studies; 367 children |
Systematic review to examine the optimal neuroradiological investigation strategy to identify inflicted brain injury. |
Combining MRI with an abnormal early CT revealed additional information in 25% (95% CI: 18.3%-33.16%) of children. Optimal imaging strategy involves initial CT, followed by early MRI and diffusion-weighted imaging if early CT examination is abnormal, or there are ongoing clinical concerns. |
4 |
| 28. Mehta H, Acharya J, Mohan AL, Tobias ME, LeCompte L, Jeevan D. Minimizing Radiation Exposure in Evaluation of Pediatric Head Trauma: Use of Rapid MR Imaging. AJNR Am J Neuroradiol. 37(1):11-8, 2016 Jan. |
Observational-Dx |
103 patients |
To assess the validity of rapid magnetic resonance (MR) imaging to replace computed tomography (CT) in the follow-up imaging of patients with head trauma. |
There was almost perfect agreement in the ability to detect extra-axial hemorrhage on rapid MR imaging and CT (k = 0.84, P < .001). Evaluation of hemorrhagic contusion/intraparenchymal hemorrhage demonstrated a moderate level of agreement between MR imaging and CT (k = 0.61, P < .001). The ability of MR imaging to detect a skull fracture also showed a substantial level of agreement with CT (k = 0.71, P < .001). Detection of diffuse axonal injury demonstrated a slight level of agreement between MR imaging and CT (k = 0.154, P =.04). However, the overall predictive agreement for the detection of an axonal injury was 91%. |
2 |
| 29. Roguski M, Morel B, Sweeney M, et al. Magnetic resonance imaging as an alternative to computed tomography in select patients with traumatic brain injury: a retrospective comparison. J Neurosurg Pediatrics. 15(5):529-34, 2015 May. |
Observational-Dx |
30 patients |
To evaluate the sensitivity of Magnetic Resonance Imaging (MRI) in the setting of acute Traumatic head injury (THI) |
The mean age of the 30-patient cohort was 8.5 ± 6.7 years, and 63.3% were male. The mean Injury Severity Score was 13.7 ± 9.2, and the mean Glasgow Coma Scale score was 9 ± 5.7. Radiology reports noted 150 abnormal findings. CT scanning missed findings in 12 patients; the missed findings included DAI (n = 5), subarachnoid hemorrhage (n = 6), small subdural hematomas (n = 6), cerebral contusions (n = 3), and an encephalocele. The CT scan was negative in 3 patients whose subsequent MRI revealed findings. MRI missed findings in 13 patients; missed findings included skull fracture (n = 5), small subdural hematomas (n = 4), cerebral contusions (n = 3), subarachnoid hemorrhage (n = 3), and DAI (n = 1). MRI was negative in 1 patient whose preceding CT scan was read as positive for injury. Although MRI more frequently reported intracranial findings than CT scanning, there was no statistically significant difference between CT and MRI in the detection of any intracranial injury (p = 0.63), DAI (p = 0.22), or intracranial hemorrhage (p = 0.25). CT scanning tended to more frequently identify skull fractures than MRI (p = 0.06). |
2 |
| 30. Ryan ME, Jaju A, Ciolino JD, Alden T. Rapid MRI evaluation of acute intracranial hemorrhage in pediatric head trauma. Neuroradiology. 58(8):793-9, 2016 Aug. |
Observational-Dx |
61 patients |
To investigate the sensitivity of rapid magnetic resonance imaging (MRI) for detection and follow-up of acute intracranial hemorrhage in comparison to computed tomography (CT), which is commonly the first-line imaging. |
One hundred two acute hemorrhages in 61 patients were identified by CT. Rapid MRI detection of subdural and epidural hemorrhages was modest in the absence of prior CT for comparison (sensitivity 61–74 %), but increased with review of the prior CT (sensitivity 80–86 %). Hemorrhage size was a significant predictor of detection (p < 0.0001). Three plane fast T2 images alone without GRE sequences were poor at detecting subarachnoid hemorrhage (sensitivity 10–25 %); rapid MRI with GRE sequences identified the majority of subarachnoid hemorrhage (sensitivity 71–93 %). GRE modestly increased detection of other extra-axial hemorrhages. |
2 |
| 31. Thiam DW, Yap SH, Chong SL. Clinical Decision Rules for Paediatric Minor Head Injury: Are CT Scans a Necessary Evil?. Ann Acad Med Singapore. 44(9):335-41, 2015 Sep. |
Observational-Dx |
1179 patients |
To evaluate the performance of High performing clinical decision rules (CDRs) rules in the Singapore population |
A total of 1179 children were included in this study. Twelve (1%) CT scans were ordered; 6 (0.5%) of them had positive findings. The application of the CDRs would have resulted in a significant increase in the number of children being subjected to CT (as follows): CATCH 237 (20.1%), CHALICE 282 (23.9%), PECARN high- and intermediate-risk 456 (38.7%), PECARN high-risk only 45 (3.8%). The CDRs demonstrated sensitivities of: CATCH 100% (54.1 to 100), CHALICE 83.3% (35.9 to 99.6), PECARN 100% (54.1 to 100), and specificities of: CATCH 80.3% (77.9 to 82.5), CHALICE 76.4% (73.8 to 78.8), PECARN high- and intermediate-risk 61.6% (58.8 to 64.4) and PECARN high-risk only 96.7% (95.5 to 97.6). |
3 |
| 32. Parri N, Crosby BJ, Glass C, et al. Ability of emergency ultrasonography to detect pediatric skull fractures: a prospective, observational study. J Emerg Med. 44(1):135-41, 2013 Jan. |
Observational-Dx |
55 patients |
To determine if bedside Emergency Department (ED) ultrasound is an accurate diagnostic tool for identifying skull fractures when compared to head computed tomography (CT). |
Bedside emergency ultrasound performs with 100% sensitivity (95% confidence interval [CI] 88.2-100%) and 95% specificity (95% CI 75.0-99.9%) when compared to CT scan for the diagnosis of skull fractures. Positive and negative predictive values were 97.2% (95% CI 84.6-99.9%) and 100% (95% CI 80.2-100%), respectively. |
2 |
| 33. Nakahara K, Shimizu S, Utsuki S, et al. Linear fractures occult on skull radiographs: a pitfall at radiological screening for mild head injury. J Trauma. 2011;70(1):180-182. |
Observational-Dx |
278 patients |
To compare the visualization of atypical linear fractures that is not easily seen on routine skull radiographs with their detection on CT scans and alert to diagnostic pitfalls. |
Of the 278 patients aged between 2 months and 66 years, 8 (2.9%) manifested a linear fracture on CT scans that presented as a cross section of the fracture oblique to the direction of the x-rays. 4/8 developed acute epidural hematoma; 2 of these patients underwent craniotomy. |
4 |
| 34. Jones TS, Burlew CC, Kornblith LZ, et al. Blunt cerebrovascular injuries in the child. American Journal of Surgery. 204(1):7-10, 2012 Jul. |
Review/Other-Dx |
45 patients |
To describe the incidence, injury patterns, and stroke rates of pediatric patients sustaining blunt cerebrovascular injuries. |
45 patients sustained blunt cerebrovascular injuries (60% male; mean age, 13 +/- .7 years; mean Injury Severity Score, 23 +/- 2). Three patients exsanguinated, and 10 presented with stroke; neurologic changes occurred 17 +/- 6 hours after injury (range, 1-72 hours). Screening indications were present in 30%. 32 asymptomatic patients were diagnosed. All but 1 received antithrombotic agents; 1 patient had neurologic deterioration despite heparinization. Comparing asymptomatic patients with those with stroke, there was a significant difference in age (15 vs 11 years). |
4 |
| 35. Kopelman TR, Berardoni NE, O'Neill PJ, et al. Risk factors for blunt cerebrovascular injury in children: do they mimic those seen in adults? J Trauma. 2011;71(3):559-564; discussion 564. |
Review/Other-Dx |
128 patients |
To determine whether adult criteria translate to the pediatric population. Eastern Association for the Surgery of Trauma guideline for the evaluation of blunt cerebrovascular injury states that pediatric trauma patients should be evaluated using the same criteria as the adult population. |
1,209 pediatric trauma patients were admitted during the study period. While 128 patients met criteria on retrospective review for evaluation based on Eastern Association for the Surgery of Trauma criteria, only 52 patients (42%) received subsequent radiographic evaluation. In all, 14 carotid artery or vertebral artery injuries were identified in 11 patients (all admissions, 0.9% incidence; all screened, 21% incidence). Adult risk factors were present in 91% of patients diagnosed with an injury. Major thoracic injury was found in 67% of patients with carotid artery injuries. Cervical spine fracture was found in 100% of patients with vertebral artery injuries. Stroke occurred in 4 patients (36%). Stroke rate after admission for untreated patients was 38% (3/8) vs 0.0% in those treated (0/2). Mortality was 27% because of concomitant severe TBI. |
4 |
| 36. Claret Teruel G, Palomeque Rico A, Cambra Lasaosa FJ, Catala Temprano A, Noguera Julian A, Costa Clara JM. Severe head injury among children: computed tomography evaluation as a prognostic factor. J Pediatr Surg. 2007;42(11):1903-1906. |
Review/Other-Dx |
156 pediatric patients |
To determine clinical characteristics and outcome of severely head-injured children admitted to the pediatric intensive care unit of a pediatric third-level university hospital and to evaluate the use of neuroimaging as a prognostic factor of morbimortality in these patients. |
Data for 156 pediatric patients, aged 1 to 18 years, were collected. The authors reclassified neuroimaging patterns into 2 groups: those with few imaging findings and those with important lesions. These 2 groups were significantly correlated with initial GCS (P<.05). The authors classified patients into favorable evolution, moderate disability, and unfavorable evolution. Poorer evolution correlated with poorer initial neuroimaging patterns, and these differences were statistically significant (P<.05). |
4 |
| 37. Sepelyak K, Gailloud P, Jordan LC. Athletics, minor trauma, and pediatric arterial ischemic stroke. Eur J Pediatr. 2010;169(5):557-562. |
Review/Other-Dx |
3 cases |
To describe three cases of sports-related stroke in previously healthy school-age children and discuss acute and long-term stroke care. |
These three cases are representative of sports-related arterial ischemic stroke, which is often associated with arterial dissection after neck trauma. Stroke mechanism is not always clear. When arterial dissection is strongly suspected based on clinical history, thorough vascular imaging with multiple modalities may be required to definitively exclude dissection. Screening for hypercoaguable state is also mandatory. |
4 |
| 38. Sarioglu FC, Sahin H, Pekcevik Y, Sarioglu O, Oztekin O. Pediatric head trauma: an extensive review on imaging requisites and unique imaging findings. [Review]. Eur. j. trauma emerg. surg.. 44(3):351-368, 2018 Jun. |
Review/Other-Dx |
N/A |
To describe differences of algorithms for children with head trauma, the mechanism of traumatic brain injury with radiological imaging findings in the pediatric population, and explain complications of undiagnosed traumatic brain lesions. |
No results stated in the abstract. |
4 |
| 39. Sigmund GA, Tong KA, Nickerson JP, Wall CJ, Oyoyo U, Ashwal S. Multimodality comparison of neuroimaging in pediatric traumatic brain injury. Pediatr Neurol. 2007;36(4):217-226. |
Observational-Dx |
40 children and adolescents |
Several imaging methods were assessed in children with TBI: CT, T2-weighted MRI, fluid-attenuated inversion recovery MRI, and SWI MRI to determine which of these methods of detection of pediatric TBI was most accurate at predicting outcome. |
T2-weighted, fluid-attenuated inversion recovery, and SWI showed no significant difference in lesion volume between normal and mild outcome groups, but did indicate significant differences between normal and poor and between mild and poor outcome groups. CT revealed no significant differences in lesion volume between any groups. The findings suggest that T2-weighted, fluid-attenuated inversion recovery, and SWI MRI sequences provide a more accurate assessment of injury severity and detection of outcome-influencing lesions than does CT in pediatric TBI patients. Although CT was inconsistent at lesion detection/outcome prediction, it remains an essential part of the acute TBI work-up to assess the need for neurosurgical intervention. |
2 |
| 40. Kpelao E, Beketi KA, Moumouni AK, et al. Clinical profile of subdural hematomas: dangerousness of subdural subacute hematoma. Neurosurg Rev. 39(2):237-40; discussion 240, 2016 Apr. |
Review/Other-Dx |
63 patients |
To show the dangerousness of equating subacute subdural hematomas to chronic subdural hematomas by establishing the clinically evolving profile of the three types of subdural hematomas. |
The average age of patients was 58.1 years for chronic subdural hematomas and 47.6 years for subacute subdural hematomas. Disease duration before admission was 13.1 days for chronic against 36.6 h for subacute hematoma. The clinical profile shows acute worsening within hours during the second week for patients with subacute hematoma, while it is progressive for patients with chronic hematoma. We noted two deaths, all victims of a subacute hematoma (one operated, one patient waiting for surgery). Iso-density hematoma on CT, especially in a young person, must be considered as a predictive factor of rapid neurological aggravation suggesting an urgent care or increased monitoring by paramedics. |
4 |
| 41. Guenette JP, Shenton ME, Koerte IK. Imaging of Concussion in Young Athletes. [Review]. Neuroimaging Clin N Am. 28(1):43-53, 2018 Feb. |
Review/Other-Dx |
N/A |
To discuss results from advanced imaging techniques and emphasizes imaging modalities that will likely become available in the near future for the clinical evaluation of concussed young athletes. |
No results stated in the abstract. |
4 |
| 42. Pinto PS, Meoded A, Poretti A, Tekes A, Huisman TA. The unique features of traumatic brain injury in children. review of the characteristics of the pediatric skull and brain, mechanisms of trauma, patterns of injury, complications, and their imaging findings--part 2. J Neuroimaging. 2012;22(2):e18-41. |
Review/Other-Dx |
N/A |
To comprehensively review frequent primary and secondary brain injuries and to give a short overview of two special types of pediatric TBI: birth related and nonaccidental injuries. |
High-end CT and/or MRI should be performed to guide and monitor treatment. In addition, anatomical and functional imaging data may better predict functional outcome. |
4 |
| 43. Aziz H, Rhee P, Pandit V, et al. Mild and moderate pediatric traumatic brain injury: replace routine repeat head computed tomography with neurologic examination. J Trauma Acute Care Surg. 75(4):550-4, 2013 Oct. |
Observational-Dx |
291 patients |
To evaluate the clinical efficacy of RHCT in pediatric TBI patients |
A total of 291 pediatric patients were identified; of which 191 patients received an RHCT. Routine RHCT did not lead toneurosurgical intervention in the mild andmoderate TBI group. In patients who received RHCT due to neurologic decline (n = 7),radiographic progression was seen on 85% of the patients (n = 6), with subsequent neurosurgical interventions in three patients.Two of these patients had a Glasgow Coma Scale (GCS) score of less than 8 at admission. |
3 |
| 44. Patel SK, Gozal YM, Krueger BM, et al. Routine surveillance imaging following mild traumatic brain injury with intracranial hemorrhage may not be necessary. J Pediatr Surg. 53(10):2048-2054, 2018 Oct. |
Observational-Dx |
154 patients |
To identify demographic or injury-related characteristics that may facilitate recognition of children at risk of progression with mild traumatic brain injury (mTBI). |
154 patients met inclusion criteria with mean age of 4 [0–16]; 116 sustained an tICH and 38 patients had isolated skull fractures. Repeat neuroimaging was obtained in 68 patients (59%). Only 9 patients (13%) with tICH had radiographic progression, none of which resulted in CSND. In addition, 9 patients experienced CSND, leading to neurosurgical intervention in 6 patients. Notably, none of these patients had repeat imaging prior to their neurologic changes. Both CSND and need for intervention were significantly higher in patients with epidural hematomas than other types of tICH (19.2% vs. 1.1%, p =0.002). Of 154 patients, 19 did not have documented follow-up, 135 were seen as outpatients and 65 (48%) had follow up neuroimaging. All patients who had surveillance imaging in the outpatient setting had stable or resolved tICH. |
3 |
| 45. Bonow RH, Friedman SD, Perez FA, et al. Prevalence of Abnormal Magnetic Resonance Imaging Findings in Children with Persistent Symptoms after Pediatric Sports-Related Concussion. J Neurotrauma. 34(19):2706-2712, 2017 Oct 01. |
Review/Other-Dx |
3,338 children |
To conduct a retrospective cohort study to describe the MRI findings in children with concussion |
Among 3,338 children identified with concussion, 427 underwent MRI. Only 2 (0.5%) had findings compatible with traumatic injury, consisting in both of microhemorrhage. Sixty-one patients (14.3%) had abnormal findings unrelated to trauma, including 24 nonspecific T2 changes, 15 pineal cysts, eight Chiari I malformations, and five arachnoid cysts. One child underwent craniotomy for a cerebellar hemangioblastoma after presenting with ataxia; another had cortical dysplasia resected after seizure. The 2 patients with microhemorrhage each had three previous concussions, significantly more than patients whose scans were normal (median, 1) or abnormal without injury (median, 1.5; p=0.048). |
4 |
| 46. Morgan CD, Zuckerman SL, King LE, Beaird SE, Sills AK, Solomon GS. Post-concussion syndrome (PCS) in a youth population: defining the diagnostic value and cost-utility of brain imaging. Childs Nerv Syst. 31(12):2305-9, 2015 Dec. |
Review/Other-Dx |
52 pediatric patients |
To assess the utility and cost-effectiveness of neurologic imaging two or more weeks post-injury in a cohort of youth with post-concussion syndrome (PCS). |
Of 52 patients with PCS, 23/52 (44%) had neuroimaging at least 2 weeks after the initial injury, for a total of 32 diagnostic studies. In summary, 1/19 MRIs (5.3%), 1/8 CTs (13%), and 0/5 x-rays (0%) yielded significant positive findings, none of which altered clinical management. Chronic phase neuroimaging estimated costs from these 52 pediatric patients totaled $129,025. We estimate the cost to identify a single positive finding was $21,000 for head CT and $104,500 for brain MRI. |
4 |
| 47. Rose SC, Schaffer CE, Young JA, McNally KA, Fischer AN, Heyer GL. Utilization of conventional neuroimaging following youth concussion. Brain Inj. 31(2):260-266, 2017. |
Observational-Dx |
1953 patients |
To explore the clinical factors that predict neuroimaging utilization in concussion. |
The majority of CT scans (n= 193) were obtained during the acute concussion period (mean = 2.7 days post-concussion), whereas MRI scans (n= 134) were ordered later during recovery (mean = 39.4 days post-concussion). Predictors of CT utilization included loss of consciousness, amnesia and vomiting (allp< 0.001). Prior concussion (p= 0.002) and continued participation in activity after injury (p= 0.03) predicted greater MRI utilization. Neuroimaging with either CT (p= 0.024, hazard ratio = 1.2) or MRI (p< 0.001, hazard ratio = 2.75) was associated with prolonged symptoms. Only 3.1% of CTs and 1.5% of MRIs demonstrated signs of traumatic brain injury. |
3 |
| 48. Khandelwal S, Sharma G, Gopal S, Sakhi P. Growing skull fractures/leptomeningeal cyst. Indian Journal of Radiology and Imaging 2002;12:485-86. |
Review/Other-Dx |
1 infant |
To describe a case report of a 3-month old infant with a history of fall. |
No abstract available. |
4 |
| 49. Bigler ED, Abildskov TJ, Goodrich-Hunsaker NJ, et al. Structural Neuroimaging Findings in Mild Traumatic Brain Injury. [Review]. Sports med. arthrosc. rev.. 24(3):e42-52, 2016 Sep. |
Review/Other-Dx |
N/A |
To review common neuroimaging findings in mild traumatic brain injury (mTBI), including sport-related concussion (SRC), based on computed tomography and magnetic resonance imaging (MRI). |
No results stated in abstract. |
4 |
| 50. Bartnik-Olson BL, Holshouser B, Wang H, et al. Impaired neurovascular unit function contributes to persistent symptoms after concussion: a pilot study. J Neurotrauma. 31(17):1497-506, 2014 Sep 01. |
Observational-Dx |
15 pediatric subjects |
To determine whether advanced imaging studies early after injury can provide valuable information in pediatric sports-related concussions (SRCs) patients with persistent post-concussive symptoms. |
Data were compared with 15 demographically similar (age, gender, and body mass index) controls. In the bilateral thalami, SRC patients showed reduced cerebral blood flow (CBF; p=0.02 and p=0.02) and relative cerebral blood volume (CBV; p=0.05 and p=0.03), compared with controls. NAA/creatine (Cr) and NAA/choline (Cho) ratios were reduced in the corpus callosum (p=0.003; p=0.05) and parietal white matter (p<0.001; p=0.006) of SRC subjects, compared with controls. Significant differences in DTI metrics differentiated patients with cognitive symptoms, compared with those without cognitive symptoms and controls. |
3 |
| 51. Churchill NW, Hutchison MG, Graham SJ, Schweizer TA. Connectomic markers of symptom severity in sport-related concussion: Whole-brain analysis of resting-state fMRI. Neuroimage (Amst). 18:518-526, 2018. |
Review/Other-Dx |
70 Patients |
To evaluate whole-brain functional connectivity for seventy university-level athletes using resting-state functional magnetic resonance imaging (rs-fMRI). |
Univariate analyses showed that greater symptom severity was mainly associated with lower pairwise connectivity in frontal, temporal and insular regions, along with higher connectivity in a sparser set of cerebellar regions. A novel multivariate approach also extracted two components that showed reliable covariation with symptom severity: (1) a network of frontal, temporal and insular regions where connectivity was negatively correlated with symptom severity (replicating the univariate findings); and (2) a network with anti-correlated elements of the default-mode network and sensorimotor system, where connectivity was positively correlated with symptom severity. |
4 |
| 52. Palacios EM, Yuh EL, Chang YS, et al. Resting-State Functional Connectivity Alterations Associated with Six-Month Outcomes in Mild Traumatic Brain Injury. J Neurotrauma. 34(8):1546-1557, 2017 04 15. |
Review/Other-Dx |
75 patients |
To investigate resting-state functional MRI (rsfMRI) to assess semiacute alterations in brain connectivity and its relationship with outcome measures assessed 6 months after injury. |
Alterations were found in the spatial maps of the RSNs between mTBI patients and healthy controls in networks involved in behavioral and cognition processes. These alterations were predictive of mTBI patients' outcomes at 6 months post-injury. Moreover, different patterns of reduced network interactions were found between the CT/MRI positive and CT/MRI negative patients and the control group. These rsfMRI results demonstrate that even mTBI patients not showing brain lesions on conventional CT/MRI scans can have alterations of functional connectivity at the semiacute stage that help explain their outcomes. These results suggest rsfMRI as a sensitive biomarker both for early diagnosis and for prediction of the cognitive and behavioral performance of these patients. |
4 |
| 53. American College of Radiology. ACR Appropriateness Criteria® Radiation Dose Assessment Introduction. Available at: https://www.acr.org/-/media/ACR/Files/Appropriateness-Criteria/RadiationDoseAssessmentIntro.pdf. |
Review/Other-Dx |
N/A |
To provide evidence-based guidelines on exposure of patients to ionizing radiation. |
No abstract available. |
4 |
