TY - JOUR
T1 - Low Risk of Clinically Important Traumatic Brain Injury in Children Who Tumble Down Stairs
AU - Koo, Donna C.
AU - Xie, Jennifer
AU - Price, Mitchell R.
AU - Soffer, Samuel Z.
AU - Bodenstein, Lawrence
N1 - Publisher Copyright:
© 2024 Elsevier Inc.
PY - 2025/1
Y1 - 2025/1
N2 - Background: Pediatric trauma management seeks to minimize head computed tomography (HCT) while capturing clinically important traumatic brain injuries (ciTBI). The Pediatric Emergency Care Applied Research Network (PECARN) system stratifies patients as high-, intermediate-, or low-risk for ciTBI. Although designed for free falls, we noted that PECARN criteria often are applied to tumbling down stairs (TDS), with steps estimated at 12”, though TDS rarely appeared to result in ciTBI. Methods: In a retrospective chart review of pediatric TDS patients, data was collected on mechanism of injury, clinical presentation, imaging, and incidence of ciTBI. PECARN scores were developed under three models: TDS-12 (12″ steps), TDS-8 (more accurate 8” steps), and TDS-0 (TDS not a severe mechanism). Results: 344 patients met criteria for study inclusion. Mean age was 6.3 years and 89 (26%) were <2 years. No patients had ciTBI. This included 88 patients who tumbled down 12 steps or more. Across all models, the same 7 patients (2.0%) were at high-risk for ciTBI. Intermediate- and low-risk cohorts were 287 (83%) and 50 (15%) for TDS-12, 171 (50%) and 166 (48%) for TDS-8, and 16 (4.7%) and 321 (93%) for TDS-0, respectively for each model. Under TDS-8, 116 (34%) patients shifted to the low-risk category. Under TDS-0, 271 (79%) patients shifted to the low-risk category, leaving only 23 patients (6.7%) at high- or intermediate-risk (n = 7, 16, respectively). Conclusions: In pediatric patients, the risk of ciTBI after TDS is low. TDS should not be treated as a free fall in risk assessment. Type of Study: Retrospective Modeling Study. Level of Evidence: Level III.
AB - Background: Pediatric trauma management seeks to minimize head computed tomography (HCT) while capturing clinically important traumatic brain injuries (ciTBI). The Pediatric Emergency Care Applied Research Network (PECARN) system stratifies patients as high-, intermediate-, or low-risk for ciTBI. Although designed for free falls, we noted that PECARN criteria often are applied to tumbling down stairs (TDS), with steps estimated at 12”, though TDS rarely appeared to result in ciTBI. Methods: In a retrospective chart review of pediatric TDS patients, data was collected on mechanism of injury, clinical presentation, imaging, and incidence of ciTBI. PECARN scores were developed under three models: TDS-12 (12″ steps), TDS-8 (more accurate 8” steps), and TDS-0 (TDS not a severe mechanism). Results: 344 patients met criteria for study inclusion. Mean age was 6.3 years and 89 (26%) were <2 years. No patients had ciTBI. This included 88 patients who tumbled down 12 steps or more. Across all models, the same 7 patients (2.0%) were at high-risk for ciTBI. Intermediate- and low-risk cohorts were 287 (83%) and 50 (15%) for TDS-12, 171 (50%) and 166 (48%) for TDS-8, and 16 (4.7%) and 321 (93%) for TDS-0, respectively for each model. Under TDS-8, 116 (34%) patients shifted to the low-risk category. Under TDS-0, 271 (79%) patients shifted to the low-risk category, leaving only 23 patients (6.7%) at high- or intermediate-risk (n = 7, 16, respectively). Conclusions: In pediatric patients, the risk of ciTBI after TDS is low. TDS should not be treated as a free fall in risk assessment. Type of Study: Retrospective Modeling Study. Level of Evidence: Level III.
KW - Anatomic head injury
KW - PECARN pediatric head injury
KW - Tumble down stairs
UR - http://www.scopus.com/inward/record.url?scp=85205146157&partnerID=8YFLogxK
U2 - 10.1016/j.jpedsurg.2024.161902
DO - 10.1016/j.jpedsurg.2024.161902
M3 - Article
AN - SCOPUS:85205146157
SN - 0022-3468
VL - 60
JO - Journal of Pediatric Surgery
JF - Journal of Pediatric Surgery
IS - 1
M1 - 161902
ER -