Study objective

Infants with head trauma often have subtle findings suggestive of traumatic brain injury. Prediction rules for traumatic brain injury among children with minor head trauma have not been specifically evaluated in infants younger than 3 months old. We aimed to determine the risk of clinically important traumatic brain injuries, traumatic brain injuries on computed tomography (CT) images, and skull fractures in infants younger than 3 months of age who did and did not meet the age-specific Pediatric Emergency Care Applied Research Network (PECARN) low-risk criteria for children with minor blunt head trauma.

Methods

We conducted a secondary analysis of infants <3 months old in the public use data set from PECARN’s prospective observational study of children with minor blunt head trauma. Main outcomes included (1) clinically important traumatic brain injury, (2) traumatic brain injury on CT, and (3) skull fracture on CT.

Results

Of 10,904 patients <2 years old, 1,081 (9.9%) with complete data were <3 months old; most (750/1081, 69.6%) sustained falls, and 633/1081 (58.6%) underwent CT scans. Of the 514/1081 (47.5%) infants who met the PECARN low-risk criteria, 1/514 (0.2%, 95% confidence interval [CI] 0.005% to 1.1%), 10/197 (5.1%, 2.5% to 9.1%), and 9/197 (4.6%, 2.1% to 8.5%) had clinically important traumatic brain injuries, traumatic brain injuries on CT, and skull fractures, respectively. Of 567 infants who did not meet the low-risk PECARN criteria, 24/567 (4.2%, 95% CI 2.7% to 6.2%), 94/436 (21.3%, 95% CI 17.6% to 25.5%), and 122/436 (28.0%, 95% CI 23.8% to 32.5%) had clinically important traumatic brain injuries, traumatic brain injuries, and skull fractures, respectively.

Conclusion

The PECARN traumatic brain injury low-risk criteria accurately identified infants <3 months old at low risk of clinically important traumatic brain injuries. However, infants at low risk for clinically important traumatic brain injuries remained at risk for traumatic brain injuries on CT, suggesting the need for a cautious approach in these infants.

中文翻译：

---

3 个月以下婴儿轻微钝性头部创伤的外伤性脑损伤风险

学习目标

头部外伤的婴儿通常有暗示外伤性脑损伤的微妙发现。尚未在 3 个月以下的婴儿中对轻微头部外伤儿童的外伤性脑损伤预测规则进行专门评估。我们旨在确定符合和不符合特定年龄儿科紧急护理应用研究的 3 个月以下婴儿发生具有临床意义的创伤性脑损伤、计算机断层扫描 (CT) 图像上的创伤性脑损伤和颅骨骨折的风险轻微钝性头部外伤的儿童网络 (PECARN) 低风险标准。

方法

我们对来自 PECARN 对轻微钝性头部创伤儿童的前瞻性观察研究的公共使用数据集中的 3 个月以下婴儿进行了二次分析。主要结果包括（1）临床上重要的外伤性脑损伤，（2）CT 上的外伤性脑损伤，和（3）CT 上的颅骨骨折。

结果

在 10,904 名 <2 岁的患者中，有完整数据的 1,081 (9.9%) 名小于 3 个月；大多数 (750/1081, 69.6%) 持续跌倒，633/1081 (58.6%) 接受 CT 扫描。在符合 PECARN 低风险标准的 514/1081 (47.5%) 名婴儿中，1/514 (0.2%，95% 置信区间 [CI] 0.005% 至 1.1%)，10/197 (5.1%，2.5% 至9.1%）和 9/197（4.6%、2.1% 至 8.5%）分别有临床上重要的外伤性脑损伤、CT 上的外伤性脑损伤和颅骨骨折。在不符合低风险 PECARN 标准的 567 名婴儿中，24/567（4.2%，95% CI 2.7% 至 6.2%）、94/436（21.3%，95% CI 17.6% 至 25.5%）和 122 /436 (28.0%, 95% CI 23.8% to 32.5%) 分别有临床上重要的外伤性脑损伤、外伤性脑损伤和颅骨骨折。

结论

PECARN 创伤性脑损伤低风险标准准确地识别出<3 个月大的婴儿，其具有临床上重要的创伤性脑损伤的低风险。然而，临床上重要的外伤性脑损伤风险低的婴儿在 CT 上仍然有外伤性脑损伤的风险，这表明需要对这些婴儿采取谨慎的方法。