• Sahin Hanalioglu, Damla Hanalioglu, Cagri Elbir, Ahmet Gulmez, Omer Selcuk Sahin, Balkan Sahin, Mehmet Erhan Turkoglu, and Huseyin Hayri Kertmen.
• Department of Neurosurgery, University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey; Department of Neurosurgery, Hacettepe University Faculty of Medicine, Ankara, Turkey. Electronic address: sahinhanalioglu@gmail.com.
• World Neurosurg. 2022 Sep 1; 165: e102e109e102-e109.

BackgroundThe necessity of computed tomography (CT) has been questioned in pediatric mild traumatic brain injury (mTBI) because of concerns related to radiation exposure. Distinguishing patients with lower and higher risk of clinically important TBI (ciTBI) is paramount to the optimal management of these patients.ObjectiveThis study aimed to analyze the imaging predictors of ciTBI and develop an algorithm to identify patients at low and high risk for ciTBI to inform clinical decision making using a large single-center cohort of pediatric patients with mTBI.MethodsWe retrospectively identified pediatric patients with mTBI with repeat CT within 48 hours of injury using an institutional database.ResultsAmong 3867 pediatric patients, 219 patients with mTBI with repeat CT were included. Thirty-eight had ciTBI (17%), 16 (7%) required intensive care unit admission, and 6 (3%) underwent surgery. Median time interval between initial and repeat CT was 7 hours (range, 4-10). Clinical worsening and radiologic progression were evident in 36 (16%) and 24 (11%) patients, respectively. Multivariate analysis showed that 5 pathologic findings (depressed skull fracture, pneumocephalus, epidural hematoma, subdural hematoma, and contusion) on initial CT and radiologic progression on repeat CT were independent predictors of ciTBI. A new scoring system based on these 5 factors on initial CT (IniCT [Initial CT scoring system] score) had excellent discrimination for ciTBI, need for intensive care unit admission, and neurosurgery (area under the curve >0.8).ConclusionsThe IniCT scoring system can successfully differentiate low-risk and high-risk patients based on initial CT scan. Zero score can eliminate the need for a routine repeat CT, whereas scores ≥2 should prompt serial neurologic examinations and/or repeat CT depending on the clinical situation.Copyright © 2022 Elsevier Inc. All rights reserved.

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