Isolated Loss of Consciousness in Children with Minor Blunt Head Trauma: Lee LK, Monroe D, Bachman MC, et al. JAMA Pediatr 2014;168:837–43.

Abstract

The objective of this study was to determine the risk for clinically important traumatic brain injury (ciTBI) in children with isolated loss of consciousness (LOC) > 5 s as a result of a traumatic event. This investigation was a planned secondary analysis of a large prospective multicenter cohort study conducted by the Pediatric Emergency Care Applied Research Network (PECARN). The study included 42,412 children ages 0–18 years with blunt head trauma and Glasgow Come Scale scores of 14 and 15 evaluated in 25 emergency departments from 2004–2006. The primary outcome for the study was ciTBI defined as death, neurosurgery, intubation > 24 h, or hospitalization for ≥ 2 nights. The investigators also compared the rates of ciTBI in children without LOC, any LOC, and isolated LOC (without other PECARN ciTBI predictors). A total of 40,693 children were included in the study. Of the participants, LOC occurred in 15.4% (6286 children). With any history of LOC the ciTBI was 2.5%, and for no history of LOC the ciTBI was 0.5% (difference 2.0%; 95% confidence interval [CI] 1.7–2.5). The ciTBI rate in children with isolated LOC, with no other PECARN predictors for ciTBI, was 0.5% (95% CI 0.2–0.8). In comparing children with isolated LOC with those who have LOC and other PECARN predictors, the risk ratio (RR) for ciTBI in children younger than 2 years was 0.13 (95% CI 0.005–0.72) and the RR for children 2 years or older was 0.10 (95% CI 0.06–0.19). The investigators concluded that children with minor blunt head trauma with isolated LOC are at low risk for ciTBI, and therefore do not routinely require computed tomography of the brain.