Mild traumatic brain injury in children with ventricular shunts: a PREDICT study

Babl, Franz E, Lyttle, Mark D, Phillips, Natalie, Kochar, Amit, Dalton, Sarah, Cheek, John A, Furyk, Jeremy, Neutze, Jocelyn, Bressan, Silvia, Williams, Amanda, Hearps, Stephen JC, Oakley, Ed, Davis, Gavin A, Dalziel, Stuart R and Borland, Meredith L 2021, Mild traumatic brain injury in children with ventricular shunts: a PREDICT study, Journal of neurosurgery: pediatrics, vol. 27, no. 2, pp. 196-202, doi: 10.3171/2020.7.PEDS2090.

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Title Mild traumatic brain injury in children with ventricular shunts: a PREDICT study
Author(s) Babl, Franz E
Lyttle, Mark D
Phillips, Natalie
Kochar, Amit
Dalton, Sarah
Cheek, John A
Furyk, JeremyORCID iD for Furyk, Jeremy
Neutze, Jocelyn
Bressan, Silvia
Williams, Amanda
Hearps, Stephen JC
Oakley, Ed
Davis, Gavin A
Dalziel, Stuart R
Borland, Meredith L
Journal name Journal of neurosurgery: pediatrics
Volume number 27
Issue number 2
Start page 196
End page 202
Total pages 7
Publisher American Association of Neurological Surgeons
Place of publication Charlottesville, Va.
Publication date 2021-02-01
ISSN 1933-0707
Keyword(s) child
traumatic brain injury
ventricular shunt
Summary OBJECTIVE Current clinical decision rules (CDRs) guiding the use of CT scanning in pediatric traumatic brain injury (TBI) assessment generally exclude children with ventricular shunts (VSs). There is limited evidence as to the risk of abnormalities found on CT scans or clinically important TBI (ciTBI) in this population. The authors sought to determine the frequency of these outcomes and the presence of CDR predictor variables in children with VSs. METHODS The authors undertook a planned secondary analysis on children with VSs included in a prospective external validation of 3 CDRs for TBI in children presenting to 10 emergency departments in Australia and New Zealand. They analyzed differences in presenting features, management and acute outcomes (TBI on CT and ciTBI) between groups with and without VSs, and assessed the presence of CDR predictors in children with a VS. RESULTS A total of 35 of 20,137 children (0.2%) with TBI had a VS; only 2 had a Glasgow Coma Scale score < 15. Overall, 49% of patients with a VS underwent CT scanning compared with 10% of those without a VS. One patient had a finding of TBI on CT scanning, with positive predictor variables on CDRs. This patient had a ciTBI. No patient required neurosurgery. For children with and without a VS, the frequency of ciTBI was 2.9% (95% CI 0.1%–14.9%) compared with 1.4% (95% CI 1.2%–1.6%) (difference 1.5% [95% CI −4.0% to 7.0%]), and TBI on CT 2.9% (95% CI 0.1%–14.9%) compared with 2.0% (95% CI 1.8%–2.2%) (difference 0.9%, 95% CI −4.6% to 6.4%). CONCLUSIONS The authors’ data provide further support that the risk of TBI is similar for children with and without a VS.
Language eng
DOI 10.3171/2020.7.PEDS2090
Indigenous content off
Field of Research 1114 Paediatrics and Reproductive Medicine
HERDC Research category C1 Refereed article in a scholarly journal
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Document type: Journal Article
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