The Prevalence of Traumatic Brain Injuries After Minor Blunt Head Trauma in Children With Ventricular Shunts

• Published in: Annals of emergency medicine 2013-04, Vol.61 (4), p.389-393
• Main Authors: Nigrovic, Lise E., MD, MPH, Lillis, Kathleen, MD, Atabaki, Shireen M., MD, MPH, Dayan, Peter S., MD, MSc, Hoyle, John, MD, Tunik, Michael G., MD, Jacobs, Elizabeth S., MD, Monroe, David, MD, Wootton-Gorges, Sandra W., MD, Miskin, Michelle, MS, Holmes, James F., MD, MPH, Kuppermann, Nathan, MD, MPH
• Format: Article
• Language: English
• Subjects: Brain Injuries - epidemiology; Brain Injuries - etiology; Cerebrospinal Fluid Shunts - adverse effects; Child, Preschool; Emergency; Glasgow Coma Scale; Head Injuries, Closed - complications; Head Injuries, Closed - diagnostic imaging; Humans; Infant; Neuroimaging; Prevalence; Prospective Studies; Tomography, X-Ray Computed
• ISSN: 0196-0644; 1097-6760
• DOI: 10.1016/j.annemergmed.2012.08.030

Study objective We compare the prevalence of clinically important traumatic brain injuries and the use of cranial computed tomography (CT) in children with minor blunt head trauma with and without ventricular shunts. Methods We performed a secondary analysis of a prospective observational cohort study of children with blunt head trauma presenting to a participating Pediatric Emergency Care Applied Research Network emergency department. For children with Glasgow Coma Scale (GCS) scores greater than or equal to 14, we compared the rates of clinically important traumatic brain injuries (defined as a traumatic brain injury resulting in death, neurosurgical intervention, intubation for more than 24 hours, or hospital admission for at least 2 nights for management of traumatic brain injury in association with positive CT scan) and use of cranial CT for children with and without ventricular shunts. Results Of the 39,732 children with blunt head trauma and GCS scores greater than or equal to 14, we identified 98 (0.2%) children with ventricular shunts. Children with ventricular shunts had more frequent CT use: (45/98 [46%] with shunts versus 13,858/39,634 [35%] without; difference 11%; 95% confidence interval 1% to 21%) but a similar rate of clinically important traumatic brain injuries (1/98 [1%] with shunts versus 346/39,619 [0.9%] without; difference 0.1%; 95% confidence interval −0.3% to 5%). The one child with a ventricular shunt who had a clinically important traumatic brain injury had a known chronic subdural hematoma that was larger after the head trauma compared with previous CT; the child underwent hematoma evacuation. Conclusion Children with ventricular shunts had higher CT use with similar rates of clinically important traumatic brain injuries after minor blunt head trauma compared with children without ventricular shunts.