A Matched-Cohort Study of Pediatric Head Injuries: Collecting Data to Inform an Evidence-Based Triage Assessment

Abstract

Triage nurses are the "first stop" for patients who present to the emergency department for care. The assessment of pediatric head injuries is especially challenging because signs and symptoms of head trauma in children do not correlate well with the risk of closed head injury (CHI). A retrospective matched cohort study was conducted to compare 2 groups of patients who presented to a pediatric emergency department for evaluation of a head injury: a CHI-positive cohort and a CHI-negative cohort as identified by computed tomography scan. The purpose of the chart review was to collect specific information from both cohorts which could be used to inform a nurse-driven pediatric head injury assessment tool. The younger the child, the more likely they were to be asymptomatic. Scalp hematomas in infants <3 months were associated with CHI even if the infants were otherwise asymptomatic. Injuries to the temporal-parietal region were associated with CHI at every age. Frequency of caregiver report of loss of consciousness (LOC) was almost identical in both cohorts. Children in every age category sustained CHIs as the result of minor falls based on standard age-related fall criteria. The infants and children at highest risk for CHI are often the most difficult to assess. The results of this study reinforce the need for a nurse-driven, evidence-based risk scoring system that could be used to aid with early identification of infants and children who are at high risk for CHI.