【两分钟医学英语】临床决策工具可用于区分脑外伤和颅内损伤儿童转入ICU的需求

Clinical decision tool may discriminate need for ICU in children with traumatic brain injury and intracranial injury

1. Based on this secondary analysis of a prospective cohort study, certain clinical features, including lower GCS score, and head CT findings, including midline shift, depressed skull fracture and epidural hematoma, were predictive of need for intensive care unit (ICU) in children with mild traumatic brain injury and intracranial injury.


2. The Children’s Intracranial Injury Decision Aid (CHIIDA) score (0 to 24 points) was based on the aforementioned factors, and had a negative predictive value (NPV) of requiring ICU with 0 points of 98.8%. Any score greater than zero, however, was not helpful in determining the appropriate disposition for the patient, meaning that there may still be an overuse of resources when using this tool.


Evidence Rating Level: 2 (Good)

There has been an increasing understanding of the risks and consequences of mild traumatic brain injury (mTBI) and intracranial injury (ICI). However appropriate, evidence-based risk assessment scores to be used with computer tomographic (CT) imaging have not been created. These scores may improve patient safety and appropriation of resources. This retrospective analysis of the Pediatric Emergency Care Applied Research Network (PECARN) head injury cohort study aimed to derive a risk score predicting the need for the ICU in children with mTBI and ICI.


For the composite outcome of need for ICU, neurosurgical intervention, intubation, and death from TBI, the only clinically significant variable was lower GCS score. CT head predictors included midline shift, presence of a depressed skull fracture, and epidural hematoma. Using this data, the authors created the Children’s Intracranial Injury Decision Aid (CHIIDA) score, ranging from 0 to 24 points. The NPV of requiring the ICU with score 0 points was 98.8%. The strength of this study was the use of a large pediatric cohort. However, the poor positive predictive value of the score limits its use in determining the disposition for many of the patients with mTBI and ICI.

来源：JAMA Pediatr. Published online February 13, 2017. doi:10.1001/jamapediatrics.2016.4520

https://jamanetwork.com/journals/jamapediatrics/fullarticle/2601243