The American journal of emergency medicine · 2026
The impact of previous head trauma and history of cranial surgery on clinical findings in acute pediatric head injury.
СтатьяНазвание и аннотация: Перевод в очереди
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Karakoyun Salih, Selki Kudret, Karakoyun Ali Rıza, Boğan Mustafa
Аннотация
BACKGROUND: This study aimed to identify independent predictors of intracranial pathology in children presenting with acute blunt head trauma, with a particular focus on patients who had a history of previous head trauma or cranial surgery and did not meet the PECARN (Pediatric Emergency Care Applied Research Network) criteria for cranial computed tomography (CCT). The study further sought to evaluate the impact of these historical factors on acute clinical findings and to inform more objective decision-making for CCT use in this specific subgroup.
METHODS: In this prospective cohort study, indications for cranial computed tomography (CCT) were determined based on PECARN criteria. Demographic characteristics, trauma mechanism, mode of presentation, symptoms, physical examination findings, scalp hematoma characteristics, Glasgow Coma Scale (GCS) scores, and CCT findings were recorded for all patients. Subgroup analyses were performed based on previous head trauma and cranial surgery history.
RESULTS: Among 1495 enrolled patients, intracranial pathology (skull fracture and/or intracranial hemorrhage) was detected in 2.6% (n = 39) on CCT. Lower GCS (≤14), arrival by ambulance, vomiting, and abnormal mental status were significantly associated with intracranial pathology (all p < 0.05). Temporal (OR: 16.35; 95% CI: 3.57-74.76; p < 0.001), parietal (OR: 10.38; p < 0.001), occipital (OR: 6.20; p = 0.008), and frontal (OR: 4.99; p < 0.001) scalp hematomas were independently associated with intracranial pathology. Younger age (OR: 0.83; p < 0.001) and lower GCS (OR: 0.67; p = 0.021) were also identified as independent risk factors for predicting intracranial injury. Among 361 patients (24.1%) with a history of head trauma and 16 patients (1.1%) with a history of cranial surgery, the rate of intracranial pathology was comparable to that of the general population (all p > 0.05).
CONCLUSIONS: The PECARN clinical decision rule allows clinicians to safely avoid unnecessary cranial CT imaging in low-risk cases owing to its high sensitivity and negative predictive value. Furthermore, previous head trauma or a history of cranial surgery was not found to increase the risk of new-onset acute intracranial injury.
METHODS: In this prospective cohort study, indications for cranial computed tomography (CCT) were determined based on PECARN criteria. Demographic characteristics, trauma mechanism, mode of presentation, symptoms, physical examination findings, scalp hematoma characteristics, Glasgow Coma Scale (GCS) scores, and CCT findings were recorded for all patients. Subgroup analyses were performed based on previous head trauma and cranial surgery history.
RESULTS: Among 1495 enrolled patients, intracranial pathology (skull fracture and/or intracranial hemorrhage) was detected in 2.6% (n = 39) on CCT. Lower GCS (≤14), arrival by ambulance, vomiting, and abnormal mental status were significantly associated with intracranial pathology (all p < 0.05). Temporal (OR: 16.35; 95% CI: 3.57-74.76; p < 0.001), parietal (OR: 10.38; p < 0.001), occipital (OR: 6.20; p = 0.008), and frontal (OR: 4.99; p < 0.001) scalp hematomas were independently associated with intracranial pathology. Younger age (OR: 0.83; p < 0.001) and lower GCS (OR: 0.67; p = 0.021) were also identified as independent risk factors for predicting intracranial injury. Among 361 patients (24.1%) with a history of head trauma and 16 patients (1.1%) with a history of cranial surgery, the rate of intracranial pathology was comparable to that of the general population (all p > 0.05).
CONCLUSIONS: The PECARN clinical decision rule allows clinicians to safely avoid unnecessary cranial CT imaging in low-risk cases owing to its high sensitivity and negative predictive value. Furthermore, previous head trauma or a history of cranial surgery was not found to increase the risk of new-onset acute intracranial injury.