• Shireen M Atabaki, Ian G Stiell, Jeffrey J Bazarian, Karin E Sadow, Tien T Vu, Mary A Camarca, Scott Berns, and James M Chamberlain.
• Division of Emergency Medicine, Children's National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC 20010-2970, USA. satabaki@cnmc.org
• Arch Pediatr Adolesc Med. 2008 May 1;162(5):439-45.

ObjectivesTo develop a sensitive clinical decision rule with a high negative predictive value for the use of cranial computed tomography (CT) in minor pediatric head trauma, to identify clinical features predictive of neurosurgical intervention, and to assess clinicians' predictive abilities to determine the presence or absence of intracranial injury based on history and physical examination alone.DesignProspective observational study.SettingFour level I pediatric trauma centers.ParticipantsOne thousand patients younger than 21 years with minor head trauma undergoing cranial CT.Main Outcome MeasureIntracranial injury as demonstrated by CT and neurosurgical intervention.ResultsOf 1000 patients in the study, the mean age was 8.9 years, and 64.1% were male; 6.5% (65 of 1000) had positive findings on CT, and 9.2% (6 of 65) of these required neurosurgical intervention. Recursive partitioning identified the following variables in the decision rule: dizziness, skull defect, sensory deficit, mental status change, bicycle-related injury, age younger than 2 years, Glasgow Coma Scale score less than 15, and evidence of a basilar skull fracture. For detection of intracranial injury, the decision rule had a sensitivity of 95.4% (95% confidence interval [CI], 86.2%-98.8%), a specificity of 48.9% (95% CI, 46.6%-52.1%), and a negative predictive value of 99.3% (95% CI, 98.1%-99.8%).ConclusionsWe developed a sensitive clinical decision rule with a high NPV for detection of intracranial injury in minor pediatric head trauma. If validated, this rule could provide a useful adjunct to the physician's clinical assessment by reducing variations in practice and unnecessary cranial CT.

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