• Lois K Lee, David Monroe, Michael C Bachman, Todd F Glass, Prashant V Mahajan, Arthur Cooper, Rachel M Stanley, Michelle Miskin, Peter S Dayan, James F Holmes, Nathan Kuppermann, and Traumatic Brain Injury (TBI) Working Group of Pediatric Emergency Care Applied Research Network (PECARN).
• Division of Emergency Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.
• JAMA Pediatr. 2014 Sep 1;168(9):837-43.

ImportanceA history of loss of consciousness (LOC) is frequently a driving factor for computed tomography use in the emergency department evaluation of children with blunt head trauma. Computed tomography carries a nonnegligible risk for lethal radiation-induced malignancy. The Pediatric Emergency Care Applied Research Network (PECARN) derived 2 age-specific prediction rules with 6 variables for clinically important traumatic brain injury (ciTBI), which included LOC as one of the risk factors.ObjectiveTo determine the risk for ciTBIs in children with isolated LOC.Design, Setting, And ParticipantsThis was a planned secondary analysis of a large prospective multicenter cohort study. The study included 42 ,412 children aged 0 to 18 years with blunt head trauma and Glasgow Coma Scale scores of 14 and 15 evaluated in 25 emergency departments from 2004-2006.ExposureA history of LOC after minor blunt head trauma.Main Outcomes And MeasuresThe main outcome measures were ciTBIs (resulting in death, neurosurgery, intubation for >24 hours, or hospitalization for ≥2 nights) and a comparison of the rates of ciTBIs in children with no LOC, any LOC, and isolated LOC (ie, with no other PECARN ciTBI predictors).ResultsA total of 42 412 children were enrolled in the parent study, with 40 693 remaining in the current analysis after exclusions. Of these, LOC occurred in 15.4% (6286 children). The prevalence of ciTBI with any history of LOC was 2.5% and for no history of LOC was 0.5% (difference, 2.0%; 95% CI, 1.7-2.5). The ciTBI rate in children with isolated LOC, with no other PECARN predictors, was 0.5% (95% CI, 0.2-0.8; 13 of 2780). When comparing children who have isolated LOC with those who have LOC and other PECARN predictors, the risk ratio for ciTBI in children younger than 2 years was 0.13 (95% CI, 0.005-0.72) and for children 2 years or older was 0.10 (95% CI, 0.06-0.19).Conclusions And RelevanceChildren with minor blunt head trauma presenting to the emergency department with isolated LOC are at very low risk for ciTBI and do not routinely require computed tomographic evaluation.

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