Head Injury Research Articles

Perivascular glial reactivity is a feature of phosphorylated tau lesions in chronic traumatic encephalopathy

Chronic traumatic encephalopathy (CTE), a neurodegenerative disease associated with repetitive head injuries, is characterised by perivascular hyperphosphorylated tau (p-tau) accumulations within the depths of cortical sulci. Although the majority of CTE literature focuses on p-tau pathology, other pathological features such as glial reactivity, vascular damage, and axonal damage are relatively unexplored. In this study, we aimed to characterise these other pathological features, specifically in CTE p-tau lesion areas, to better understand the microenvironment surrounding the lesion. We utilised multiplex immunohistochemistry to investigate the distribution of 32 different markers of cytoarchitecture and pathology that are relevant to both traumatic brain injury and neurodegeneration. We qualitatively assessed the multiplex images and measured the percentage area of labelling for each marker in the lesion and non-lesion areas of CTE cases. We identified perivascular glial reactivity as a prominent feature of CTE p-tau lesions, largely driven by increases in astrocyte reactivity compared to non-lesion areas. Furthermore, we identified astrocytes labelled for both NAD(P)H quinone dehydrogenase 1 (NQO1) and L-ferritin, indicating that lesion-associated glial reactivity may be a compensatory response to iron-induced oxidative stress. Our findings demonstrate that perivascular inflammation is a consistent feature of the CTE pathognomonic lesion and may contribute to the pathogenesis of brain injury-related neurodegeneration.

Should pediatric patients with isolated skull fractures be admitted, transferred, or discharged from the emergency department, and what are the economic consequences? Original series, systematic review of the literature, and a proposed admission protocol.

Pediatric head trauma is a common reason for emergency department (ED) referrals. Skull fractures are the most common imaging findings in the setting of pediatric trauma. Ample literature negates the necessity of hospitalization for neurologically intact children with isolated skull fractures (ISFs) and when nonaccidental injuries (NAIs) are not suspected. Despite this evidence, in many centers these children are still admitted for observation. The authors performed a retrospective analysis of the outcomes of children admitted with ISFs. A literature review of studies of children with ISFs was also performed. The objective of this study was to assess the necessity of admission of children with ISF. A retrospective single-center analysis was performed, based on the electronic referral database of a tertiary pediatric hospital. Pediatric patients (< 18 years old) with a linear skull fracture on CT were included. Patients with additional traumatic intracranial findings on imaging (bleeding, pneumocephalus, edema, etc.) were excluded, as were patients with depressed, open, or displaced fractures. A systematic literature review of the Medline and PubMed databases was performed. Two hundred fifty-eight children met the criteria between 2019 and 2022. Eighty-one percent sustained a fall. Other mechanisms of injury included blunt-force trauma and road accidents, and 10.5% had an unclear mechanism. Most children had parietal fractures (56.3%), followed by occipital fractures and others. Sixteen percent suffered from chronic illnesses. No cases of growing skull fractures were noted. None of the children needed neurosurgical intervention. Moreover, none needed a follow-up CT scan. Three patients were transferred from a first-tier hospital to the authors' institution, none because of neurosurgical concerns. Other than these 3 patients, all other children were admitted to a pediatric ward for 24-hour observation and subsequently discharged. NAI was highly suspected in 7.1% of children (3/42) suffering from chronic illnesses as opposed to 1.4% (3/216) of healthy children. This difference was not statistically significant (p = 0.056). The literature review yielded 680 papers. After screening for relevance, language, etc., 8 original series with 5823 patients remained. One patient (0.017%) was operated on, but probably not for ISF. The cost difference between discharge from the ED and admission ranged between $520 and $4291 (US dollars). None of the children discharged from the ED returned for hospitalization. In this original cohort, none of the children had a change in management following their admission. None needed neurosurgical intervention. In children with linear ISFs, a short ED observation should be considered, followed by discharge based on neurological status. A proposed ED discharge protocol is presented.

Reciprocal Causation Among Pain, Physical Health, and Mental Health 1 Year Post-Traumatic Brain Injury: A Cross-Lagged Panel Model From the TRACK-TBI Study.

To estimate the relative causal influence of physical and mental health on pain in persons with traumatic brain injury (TBI) within the year following injury. Transforming Research and Clinical Knowledge in TBI (TRACK-TBI) was a multicenter study that collected data from 18 level 1 trauma centers around the United States. TRACK-TBI recruited adults who experienced an acute TBI. For this secondary analysis, participants were included if they endorsed pain during at least 1 follow-up within 1 year post-TBI. Secondary analysis using structural equation modeling of the longitudinal TRACK-TBI dataset of an inception cohort. None. The primary outcomes are pain, physical health, and mental health. Pain was measured by averaging the T-scores of the Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Intensity and Pain Interference scales. Physical and mental health were measured with the raw component scores (physical component score and mental component score, respectively) on the Short Form Health Survey. Eighty-nine percent of the TRACK-TBI cohort (n=2022) reported pain throughout 1 year postinjury. This sample (n=1796) was primarily white (77%) men (67%) in their early forties with mild (87%) closed head injuries (99%) related to motor or road vehicle accidents (57%). Based on the final trimmed model, there was a stronger dominance of pain on physical and mental health than physical and mental health on pain. Thus, pain is a bigger driver of physical and mental health than vice versa. Persistent pain is highly prevalent post-TBI and is a bigger driver of physical and mental health 1 year post-TBI than the other way round. Future research should aim to better understand the causes of pain post-TBI to inform what treatments are most effective at reducing pain intensity and interference post-TBI.

Characterization of patients with syncope in the emergency department-secondary diagnoses and laboratory parameters of inpatients versus outpatients

Over 1391 patients presented to the emergency department (ED) of a German university hospital with primary diagnosis of syncope from 2019-2022. This monocentric, retrospective study aims to characterize this cohort regarding secondary diagnoses and blood laboratory parameters. Principal focus lay on the differentiation between inpatients (n = 190; 13.7%) and outpatients (n = 1201; 86.3%). Most common secondary diagnoses comprised head injury (n = 188; 13.5%), infection (n = 126; 9.1%), body injury (n = 124; 8.9%), neurological disease (n = 85; 6.1%), arrhythmogenic heart failure (n = 76; 5.5%), cardiovascular risk factors (n = 75; 5.4%), metabolic/nephrological disease (n = 69; 5.0%), and structural heart disease (n = 68; 4.9%). Surgical interventions were performed using catheter (n = 16; 1.2%), percutaneous coronary interventions (n = 15; 1.1%), and pacemaker/defibrillator/event recorders (n = 12; 0.9%). Inpatients had significantly more secondary diagnoses (3.5 vs. 0.3) and higher incidences of abnormal laboratory parameters compared to outpatients. Secondary diagnoses more common in inpatients included cardiovascular risk factors (37.9 vs. 0.2%), arrhythmogenic heart failure (35.3 vs. 0.7%), infection (57.9 vs. 1.3%), and lung disease (6.3 vs. 0.2%). Abnormal blood laboratory values more frequent in inpatients included elevated levels of highly sensitive (hs) troponin T (58.8 vs. 25.7%), creatinine (36.2 vs. 14.8%), leukocytes (43.4 vs. 36.3%), besides decreased hemoglobin (33.3 vs. 16.0%), potassium (5.3 vs. 1.2%), and sodium (2.1 vs. 0.6%).

A Pediatric Concussion Model in Mice: Closed Head Injury with Long-Term Disorders (CHILD)

A Pediatric Concussion Model in Mice: Closed Head Injury with Long-Term Disorders (CHILD)

Prophylactic antibiotic use in trauma patients with non-operative facial fractures: A prospective AAST multicenter trial.

Craniofacial trauma affects approximately 3 million individuals in the United States annually. Historically, low overall data quality and inadequate sample size have limited the development of clinical practice guidelines for prophylactic antibiotic use in facial fractures. We sought to examine the current use patterns and effects of prophylactic antibiotics in non-operative facial fractures. A prospective analysis of adult patients with nonoperative facial fractures was conducted across 19 centers from January 2022 to December 2023. Kruskal-Wallis H, Mann-Whitney U, Pearson's χ2, Fisher's exact tests, and logistic regression models were used to evaluate the association between antibiotic duration (no antibiotics, ≤24 hours, and >24 hours) and facial fracture-associated infectious complications. Among 1,835 patients, 1,168 (63.7%) received no antibiotics and 667 (36.4%) received antibiotics (≤24 hours, n = 264 (14.4%); >24 hours, n = 403 (22.0%). Nineteen (1.0%) patients developed infectious complications (0.7% in the no antibiotic group vs. 1.7% with antibiotics). Most patients (99.0%) did not develop an infection despite the majority (63.7%) receiving no antibiotics. Injuries were predominately closed fractures (86.3%), without mucosal disruption (83.9%) or foreign bodies (97.7%). Antibiotic administration had a statistically significant association with the occurrence of infectious complications (p = 0.050). However, no significant association was seen between antibiotic duration and infectious complications following multivariable logistic regression, adjusting for confounders (≤24 hours: adjusted odds ratio, 1.24; 95% confidence interval, 0.30-5.14; p = 0.766; >24 hours: adjusted odds ratio, 1.32; 95% confidence interval, 0.37-4.69; p = 0.668). Despite most patients not receiving antibiotics, infection rates remained low. This indicates prophylactic antibiotic use does not reduce the risk of fracture-associated infections for most injury patterns. While a randomized trial is optimal to validate these data, at this time, there is no evidence to support presumptive antibiotics for closed non-operative facial fractures. Therapeutic/Care Management; Level II.

Factors influencing paramedic conveyance decisions when attending children with minor head injury: a qualitative study

IntroductionChildren with head injury are commonly transported to the ED by ambulance. However, most of those conveyed are deemed non-serious and are discharged at triage. Research is needed to explore...

Penetration of the Scalp by the Bent Fragment of a Pre-installed Titanium Mini-Plate Due to a Minor Head Injury: A Case Report

Penetration of the Scalp by the Bent Fragment of a Pre-installed Titanium Mini-Plate Due to a Minor Head Injury: A Case Report

Balneotherapy for the treatment of post-COVID syndrome: a randomized controlled trial

BackgroundPost-Acute COVID Syndrome (PACS) is a complex disorder that currently lacks effective evidenced-based therapies to manage it. This randomized controlled trial aims to evaluate the effects of balneotherapy (BT) on PACS symptomatology.MethodsNinety-eight adults with PACS visited at Hospital del Mar Research Institute, Barcelona (Spain) were included to the study. Participants in the intervention group (n = 51) were allocated to 12 sessions of BT and aquatic exercises delivered in one month while the control group (n = 47) did not. The primary outcome was to evaluate the absolute change in questionnaire scores between baseline and two follow-up points: immediately after balneotherapy (or one-month post-baseline for the control group) and 2 months post-baseline. The following scales/questionnaires were employed: Post-COVID-19 functional status scale, mMRC dyspnea Scale, SF-36, Pittsburgh Sleep Quality Index (PSQI), Hospital Anxiety and Depression Scale (HADS), Memory failures in everyday life following severe head injury, and Visual Analogic Scale (VAS).ResultsForty-seven patients in the BT group and 43 in the control group completed the study. The majority of participants were middle-aged women (> 84%; mean age 48 years), and the most prevalent symptoms were fatigue, musculoskeletal pain, and neurocognitive impairment (> 88%). Noteworthy, the vast majority did not undergo a severe primary infection (ICU admissions < 3%). After BT, significant improvement was detected in the BT group vs. the control group in various SF-36 domains, PSQI total score (Beta-coefficient [95%CI] 2.641 [1.15;4.12]; p -value = 0.003), HAD’s anxiety subscale (Beta-coefficient [95%CI] 1.72 [0.40;3.03;p-value = 0.023), and VAS (Beta-coefficient [95%CI] 1.625 [0.32;2.96]; p-value = 0.026). Among these, SF-36’s energy/fatigue and pain subscales exhibited the most prominent changes with a Beta-coefficient [95%CI] of -17.45 [-24.23;-10.66] and − 21.634 [-30.48;-12.78], respectively (p-value < 0.0001). No severe adverse effects were reported during BT although seventeen patients reported mild and transient worsening of preexisting symptoms, particularly fatigue/post-exertional malaise mainly in the first sessions of BT.ConclusionBalneotherapy comprise an effective therapeutic modality that can alleviate several symptoms that characterize PACS, particularly musculoskeletal pain and fatigue. However, the sustainability of these effects over time remains uncertain, as evidenced by the loss of some between-group differences at the one-month follow-up.Trial registrationClinicalTrials.gov NCT05765591 (13/03/2023).

American Association for the Surgery of Trauma pancreatic organ injury scale: 2024 Revision.

The American Association for the Surgery of Trauma Organ Injury Scale (OIS) Committee published the original pancreatic OIS in 1990 with the authors acknowledging at the time that the classification would need to undergo "continued refinement as clinical experience dictates." The current OIS overemphasizes injury location over ductal integrity; modifications are needed to improve concordance between OIS, therapy, and outcomes and promote accuracy in quality assessment and research. A subcommittee of the American Association for the Surgery of Trauma and invited experts in radiology and interventional gastroenterology were chosen. Contemporary literature was reviewed, and a standardized iterative and collegial process was used to arrive at consensus. The pancreatic OIS is anatomically based on operative, radiographic, or pathologic findings. Major changes to the grading system include moving lacerations of the pancreatic head without ductal injury from Grade IV to Grade II. Injuries to the duct in the neck, body, or tail remain Grade III but are further subclassified to distinguish between deep parenchymal injuries without ductal interrogation, partial ductal injuries, and complete ductal transection. Grade IV injuries follow the same nomenclature but for injuries to the right of the portal vein or superior mesenteric vein. Grade V injuries are destructive injuries of the pancreatic head with nonviable parenchyma. These injuries are further subgraded based on ductal injuries. The pancreatic OIS schema is revised based on contemporary experience informed by the current understanding of outcomes and treatment, including operative management and outcomes. Increasing grades now more closely reflect increasing severity. Expert Opinion; Level V.

A Systematic Review of Pediatric Abusive Head Trauma: What a Surgeon Needs to Know Before Using a Knife

A Systematic Review of Pediatric Abusive Head Trauma: What a Surgeon Needs to Know Before Using a Knife

Head or skull injury? Consequences of using mistranslated ICD diagnosis category: Multicenter, blinded, randomized controlled analysis.

Emergency care units in Hungary treat approximately 140-180 thousand head injuries of varying se'verity each year. These head injuries are mainly caused by traffic accidents, assaults, or domestic accidents. The outpatient care record contains details about the circumstances and underlying mechanisms of the head injury, the results of physical and imaging examinations, and therapeutic recommendations. The record also contains standardized codes for the diagnoses and the interventions performed, using the BNO (Betegségek Nemzetközi Osztályozása) classification, the Hungarian version of the international diagnostic classification system ICD (International Classification of Diseases). These records are important for financial reasons and for statistical purposes. The injury diagnoses consist of the ICD codes with the related diagnostic categories and in most cases also the corresponding Latin diagnoses describing the injuries sustained. The ICD categories often appear as Hungarian translations of the Latin diagnoses in the detailed Medical Diagnostic Reports on Injuries (MDRI). In Hungary, MDRI reports are prepared by physicians at the request of criminal prosecutors for forensic evaluation. In practice, however, MDRIs are usually based on the primary outpatient records. Head injuries are diagnosed using the codes in ICD Chapter 19, S00-S09. Translation errors may occur when ICD is adapted for different languages, resulting in different applications of certain diagnostic codes. The present study investigates the use and frequency of the ICD-10 code S07.1 in Hungarian MDRIs issued for forensic evaluation. The results of our study show that, due to an inaccurate translation, superficial head injuries (specifically, bruises) are incorrectly coded in Hungary with S07.1, which in ICD-10 is reserved for severe head injuries (crushing injury of the skull).

Comorbidity patterns and the risk of injurious falls in older people with atrial fibrillation: Findings from a Swedish nation-wide population-based study

Atrial fibrillation (AF) is associated with an increased fall risk, partly due to AF-related comorbidities. We investigated the impact of different comorbidity patterns on fall risk in older adults with AF. Using the Swedish National Patient Register, we identified 203,042 adults (45 % females) with AF and at least one comorbidity, aged 65 years or older, on 01/01/2017. The primary study outcome was any fall requiring medical attention. Secondary outcomes were falls with fractures, falls with hip fractures, and falls with head trauma. Comorbidity patterns were identified through latent class analysis, and their association with 3-year fall risk was tested through Cox regressions. The sample mean age was 79.6 (SD: 7.9) years, and the mean number of chronic diseases was 6.6 (SD 3.2). We identified one unspecific (34.2 %) and six specific comorbidity patterns characterized by neuropsychiatric (6.6 %), eye (17.4 %), musculoskeletal (7.2 %), metabolic (15.8 %), cardiovascular (7.4 %), and complex (11.3 %) chronic conditions coexisting with AF. Older adults with AF and complex (HR=1.63, 95 %CI: 1.56-1.70), neuropsychiatric (HR=1.48, 95 %CI: 1.41-1.56), cardiovascular (HR=1.21, 95 %CI: 1.15-1.27), eye (HR=1.16, 95 %CI: 1.12-1.20), and musculoskeletal (HR=1.07, 95 %CI: 1.01-1.13) comorbidity had an increased fall risk compared to those with unspecific comorbidity. The highest risk of falls with fractures or head trauma was found in older adults displaying a complex or neuropsychiatric disease pattern, respectively. Higher estimates emerged in males and those aged <80 years. Evaluating comorbidity patterns in older AF patients could help stratify the risk of falls in this population and support targeted preventive interventions.

Integrated Design and Prototyping of a Robotic Head for Ocular and Craniofacial Trauma Simulators.

Medical simulation is relevant for training medical personnel in the delivery of medical and trauma care, with benefits including quantitative evaluation and increased patient safety through reduced need to train on patients. This paper presents a prototype medical simulator focusing on ocular and craniofacial trauma (OCF), for training in management of facial and upper airway injuries. It consists of a physical, electromechanical representation of head and neck structures, including the mandible, maxillary region, neck, orbit and peri-orbital regions to replicate different craniofacial traumas. Actuation and hydraulic systems are designed to control animatronic features and flow of simulated blood, tears, and cerebrospinal fluid. Experimentally validated, the OCF simulator achieves structural and functional characteristics as close as possible to those of a human body. The OCF Simulator can be used as a stand-alone active simulator, it can be transported and used to train surgeons in simulated real-life scenarios. The authors declare that this statement is not applicable since no clinical tests have been performed.

Adults With Head and Neck Burns Experience Worse Long-Term Outcomes and Require More Reconstructive Surgeries: A Burn Model System Study.

Adults living with head and neck burn injuries experience psychosocial consequences due to scarring as well as functional disabilities. However, the impact of head and neck burns on long-term self-reported psychosocial outcomes, return to work, and need for reconstructive surgery has not been well described. This study investigates the unique longitudinal problems in psychosocial and functional recovery faced by adults with head and neck burn injuries. Utilizing the multicenter Burn Model System (BMS) National Database, long-term psychosocial and functional outcomes as well as postdischarge reconstructive surgery rates between adult participants with and without head and neck burns injured after 2014 were compared. Of 1247 participants, 579 had head and neck burns and 668 had non-head and neck burns. Head and neck burn was a significant predictor of worse anxiety (β = 1.63, P = 0.049) and body image (β = -0.30, P = 0.011) at 6 months post burn; worse anxiety (β = 2.68, P = 0.004), depression (β = 2.14, P = 0.021), and body image (β = -0.41, P = 0.001) at 12 months post burn; and worse life satisfaction (β = -1.64, P = 0.036) at 24 months post burn. Head and neck burn participants reported significantly worse anxiety ( P = 0.001), depression ( P = 0.0026), and life satisfaction ( P < 0.001) at 12 months post burn and worse body image at 6 ( P < 0.001), 12 ( P < 0.001), and 24 ( P < 0.001) months post burn. The head-and-neck group had a significantly greater proportion of participants who had undergone contracture surgery at 12 months post burn ( P < 0.001) and a smaller proportion who had returned to work by 6 ( P < 0.001) and 12 ( P < 0.001) months post burn. This study suggests that adults with head and neck burns might strongly benefit from additional counseling, psychotherapy, and greater aftercare.

Corticobasal Syndrome: Are There Central or Peripheral Triggers?

Corticobasal syndrome (CBS) is a complex of symptoms and signs comprising limb rigidity, bradykinesia, dystonia, myoclonus, apraxia, cortical sensory loss, and a variety of cognitive and language impairments. CBS is commonly seen in tauopathies. Striking asymmetry in clinical and imaging findings in CBS raises questions about potential triggers initiating neurodegeneration. The objective of this study was to investigate potential central or peripheral triggers preceding CBS symptoms. In this retrospective observational study, we reviewed medical records of patients with CBS at our Parkinson's Disease Center and Movement Disorders Clinic, focusing on evidence of possible central or peripheral "trigger" occurring within a year before the onset of CBS. We also reviewed records of patients with Parkinson disease (PD) for comparison. Of the 72 patients with CBS, 15 (20.8%) reported potential focal triggers before the onset of CBS-related neurologic symptoms. By contrast, only 1 of 72 patients with PD (1.4%) had a documented trigger before the onset of PD-related symptoms (p < 0.001). Of potential triggers, 13 were peripheral (related to hand or shoulder surgeries or trauma) and 2 were central (stroke and head trauma). Patients with CBS with triggers were younger, had earlier symptom onset, comprised a higher proportion of men, and had a higher likelihood of limb onset of symptoms than those without. Our finding of relatively high frequency of focal triggers in CBS compared with PD suggests potential central or peripheral triggers initiating neurodegeneration, possibly explaining asymmetric clinical and imaging features in CBS. Further research is necessary to validate and explore this observation's implications for CBS pathogenesis.

Beliefs About the Causes of Alzheimer's Disease Among Latinos in New York City.

Latinos face health disparities in Alzheimer's disease (AD), with high disease prevalence relative to non-Latino whites and barriers to healthcare access. Several studies have found misconceptions about AD among Latinos that were linked to reduced preventative or help-seeking behavior. To improve understanding of illness perceptions among Latinos, we examined beliefs about the causes of AD, one of the five dimensions of illness representations from Leventhal's Self-Regulation Theory, among a sample of N = 216 Latinos. We conducted in-depth, semi-structured interviews with participants aged 40 to 64 (average age 53 years) living in northern Manhattan. Seven distinct causes of AD were identified, though participants demonstrated a general understanding of AD as a multifactorial disease. Genetics was found to be the most endorsed cause of AD, followed by unhealthy lifestyle factors. Most Latinos who believed psychosocial factors played a critical role in AD development were first-generation immigrants. No participants attributed AD to a normal process of aging, and few ascribed the disease to brain damage from stroke or head injuries. Several participants expressed the belief that environmental contaminants can cause AD, which has received little mention in prior studies. Though only a small number thought AD could occur by chance, most participants remained uncertain about the exact causes of the disease and used lay knowledge to explain their beliefs. Our findings help identify areas where educational interventions would be beneficial in improving community knowledge and offer perspectives that can foster cultural competency in healthcare.

Abusive Head Trauma

Abusive Head Trauma

Self-Resolving Pulsatile Frontal Mass Following Blunt Head Trauma

Self-Resolving Pulsatile Frontal Mass Following Blunt Head Trauma

Outcomes of children transferred to a pediatric trauma center after blunt abdominal trauma: A 10-year experience

Most injured children are initially seen at non-pediatric hospitals, then transferred to a pediatric trauma center for definitive care. Published outcomes of transferred children with blunt abdominal trauma (BAT) are sparse. Our objective is to describe this population and their disposition at a pediatric trauma center. The study was performed at a level-1 pediatric trauma center (PTC) using data collected from electronic medical records and trauma registry. Patients 0-18years with BAT transferred from outside facilities (OSF) between 2009 and 2019. Penetrating injuries were excluded. 923 patients were analyzed and grouped by whether computed tomography abdominal/pelvis (CTa/p) was obtained at each facility. Those with positive CTa/p at OSF were also compared to those with positive CTa/p results at our PTC. Descriptive statistics evaluated demographics, injury mechanism, Glasgow Coma Scale (GCS), Injury Severity Scale (ISS), disposition, and length of stay (LOS). Males had higher predominance of positive CTa/p at both OSF and PTC (p=0.0012), with motor vehicle crash (MVC) being the most common injury mechanism (p=0.0002). Patients with positive CTa/p at PTC (n=156) were associated with statistically higher ISS, lower GCS, more dispositions to OR and ICU, and longer LOS (all p<0.005). Of patients with negative CTa/p at OSF (n=41), none received subsequent CTa/p upon arrival to PTC and only 2 were admitted in the setting of head trauma. Of the patients without CTa/p performed at either facility or negative CTa/p at PTC (n=23), most were admitted for non-abdominal trauma. Compared to those with positive CTa/p at OSF, children who had positive CTa/p at PTC were younger, had higher ISS scores, and longer LOS, suggesting they were more seriously injured. Children with BAT and negative CTa/p in absence of other injuries, may not require transfer to a PTC. Enhanced understanding of these patients may reduce unnecessary transfers, improving resource utilization.