A new clinical decision rule with nearly 100 per cent accuracy in ruling out intracranial injury in minor pediatric head trauma may help reduce unnecessary cranial CTs, a multicenter team of physicians reports. A new clinical decision rule with nearly 100 per cent accuracy in ruling out intracranial injury in minor pediatric head trauma may help reduce unnecessary cranial CTs, a multicenter team of physicians reports.

Dr. Shireen M. Atabaki, at Children's National Medical Center in Washington, DC, and colleagues at four level 1 pediatric trauma centers conducted a prospective observational study of 1000 pediatric patients (mean age 8.9 years) with minor closed-head trauma undergoing cranial CT. Sixty-five (6.5 per cent) had positive findings on CT, and six of these patients required neurosurgical intervention.

"Recursive partitioning resulted in the following rule for optimal prediction of intracranial injury: dizziness, sensory deficit, Glasgow Coma Scale score less than 15, mental status change, bicycle-related injury, age younger than two years, skull defect on examination, and evidence of a basilar skull fracture (Battle sign, rhinorrhea, hemotympanum, periorbital ecchymosis, or cerebrospinal fluid otorrhea)," the investigators report in the May issue of the Archives of Pediatrics and Adolescent Medicine.

The decision rule for detection of intracranial injury had a sensitivity of 95.4 per cent, a specificity of 48.9 per cent, and a negative predictive value of 99.3 per cent.

In comparison, the sensitivity of clinicians' predictions of intracranial injury based on history and physical examination was 14.8 per cent.

Dr. Atabaki and associates don't advise "blind application of the rule to all patients with minor head trauma." Instead, they recommend that it be used as "an additional tool to guide clinicians who are considering cranial CT in a child with minor head trauma."

The researchers also urge clinicians to continue follow-up for patients who are symptomatic despite negative CT findings. Eventually, they hope, "functional imaging and psychometric testing may replace CT for the assessment of the child with minor head trauma."