Clinical Features Of Head Trauma In Children And Clinical Decision Rules Of CT Examination

Objective:Head trauma in juvenile is an important worldwide health problem.The juvenile patients with head trauma account for a large part of the patients in the emergency department every year.As the first choice for emergency diagnosis of craniocerebral injury,CT examination may lead to cancers such as brain tumors and leukemia in children.The indication of cranial CT scan in children with head trauma has drawn attention.At present,some foreign studies have investigated the CT examination decisions of minors after head trauma,but there are not many domestic studies.This study explores the epidemiological characteristics and clinical features of head trauma in minors,and discusses the applicability of three clinical decision rules that are commonly used to guide CT examination in children with head trauma.The accuracy of the above three decision rules was verified and analyzed for the children.Methods:In this study,1538 children and adolescents?aged less than 18 years old?with a definite history of head trauma?regardless of the severity of injury?who were admitted to the emergency medical center of the first hospital of shanxi medical university were included.Firstly,the epidemiological data of gender,age and injury mechanism,GCS score,CT examination and other relevant clinical data were collected,and the above data were analyzed.Secondly,the child is evaluated by the receiving physician.Combined with Children's Head Injury Algorithm for the Prediction of Important Clinical Events?CHALICE?^[1],the Paediatric Emergency Care Applied Research Network?PECARN?^[2]and the Canadian Assessment of Tomography for Childhood Head Injury?CATCH?^[3]and other conditions,receiving physician determine whether cranial CT examination is needed.CT examination results of the children were independently evaluated by emergency physicians and professional imaging physicians,while expert teams composed of three or more experienced physicians were used for analysis and evaluation when there was disagreement.CT examination results,clinical diagnosis and treatment were collected and patients were followed up.According to the inclusion and exclusion criteria of the above three clinical decision rules,the clinical child cohort applicable to each rule was screened and its applicability was analyzed.The diagnostic sensitivity,specificity,positive and negative predictive values and Youden index of each cohort were calculated and the ROC curve was drawn.Results:There were 1044 male children,accounting for 67.9%.There were 495 female patients,accounting for 32.1%.Among children of different ages,males were higher than females.The number of children in early school age was the largest,followed by kindergarten and primary school,and the number of head trauma patients in middle and high school was significantly reduced.The causes of injury were:slight injury mechanism?47.92%?,fall?22.43%?,road traffic injury?17.43%?,blunt force injury?7.09%?,and other causes?5.14%?.Among them,the minor injury mechanism such as fall/bump in the early school age and kindergarten stage accounted for the first cause of injury.High fall injury in primary school was the most common.Middle and high school traffic injuries accounted for the most.Children with normal GCS score were the most at the first diagnosis,accounting for 99.22%.The CT examination rate of the head was22.0%,among which only 14.5%were positive.The rate of neurosurgical intervention was 0.5%and the mortality was about 0.1%.The application rate of CHALICE rule is 90.70%.The application rate of PECARN rule was 52.11%.The CATCH rule is applicable for 21.15%.In this study,it was found that the above CHALICE,PECARN and CATCH rules were highly sensitive in the minor population of head trauma in China that met the respective research standards.PECARN rule has the highest diagnostic sensitivity.CHALICE rule comes next;The CATCH rule is the lowest,but all are greater than 85%.The specificity of CHALICE rule,PECARN rule and CATCH rule decreases in turn.Youden index of CHALICE rule is0.707,and Youden index of PECARN and CATCH rule is around 0.5.Conclusion:The causes of head trauma in different age groups are different.The number of males in different age groups is higher than that of female children.The vast majority of minors have minor injuries to head injuries,and the positive rate of CT examination is low.The three foreign CHALICE rules,PECARN rules and CATCH rules for guiding CT examination of minors with head trauma have high sensitivity and can be used to guide the decision of CT examination of minors after head trauma.Among them,the CHALICE rule has a wider population of subjects,and has higher sensitivity,specificity and Youden index,or can be recommended first in clinical practice.