Managing Children Who Show Up Late After Head Injury

Decision rules for neuroimaging of pediatric head injury have not been validated for children who present more than 24 hours after injury. These authors examined outcomes in this subset of patients in a planned secondary analysis of a large observational study from Australia and New Zealand.

From 2011 to 2014, the authors enrolled 19,765 children (ages <18 years) who presented with head injury to one of 10 participating emergency departments. Of these patients, 981 (5%) presented >24 hours after injury. Computed tomography (CT) imaging was obtained at the discretion of the treating provider and follow-up was conducted 3 to 6 months after presentation, with clinically important brain injury defined as by PECARN.

CT scans were obtained more fre…