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Meta-Analysis
. 2004 Jul;89(7):653-9.
doi: 10.1136/adc.2003.027722.

A meta-analysis of variables that predict significant intracranial injury in minor head trauma

J Dunning  1 , J Batchelor, P Stratford-Smith, S Teece, J Browne, C Sharpin, K Mackway-Jones
Affiliations
Meta-Analysis

A meta-analysis of variables that predict significant intracranial injury in minor head trauma

J Dunning et al. Arch Dis Child. 2004 Jul.

Abstract

Background: Previous studies have presented conflicting results regarding the predictive effect of various clinical symptoms, signs, and plain imaging for intracranial pathology in children with minor head injury.

Aims: To perform a meta-analysis of the literature in order to assess the significance of these factors and intracranial haemorrhage (ICH) in the paediatric population.

Methods: The literature was searched using Medline, Embase, Experts, and the grey literature. Reference lists of major guidelines were crosschecked. Control or nested case-control studies of children with head injury who had skull radiography, recording of common symptoms and signs, and head computed tomography (CT) were selected.

Outcome variable: CT presence or absence of ICH.

Results: Sixteen papers were identified as satisfying criteria for inclusion in the meta-analysis, although not every paper contained data on every correlate. Available evidence gave pooled patient numbers from 1136 to 22 420. Skull fracture gave a relative risk ratio of 6.13 (95% CI 3.35 to 11.2), headache 1.02 (95% CI 0.62 to 1.69), vomiting 0.88 (95% CI 0.67 to 1.15), focal neurology 9.43 (2.89 to 30.8), seizures 2.82 (95% CI 0.89 to 9.00), LOC 2.23 (95% CI 1.20 to 4.16), and Glasgow Coma Scale (GCS) <15 of 5.51 (95% CI 1.59 to 19.0).

Conclusions: There was a statistically significant correlation between intracranial haemorrhage and skull fracture, focal neurology, loss of consciousness, and GCS abnormality. Headache and vomiting were not found to be predictive and there was great variability in the predictive ability of seizures. More information is required about the current predictor variables so that more refined guidelines can be developed. Further research is currently underway by three large study groups.

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Figures

Figure 1
Figure 1
Forest plot of ICH versus skull fracture.
Figure 7
Figure 7
Forest plot of ICH versus reduced GCS.
Figure 2
Figure 2
Forest plot of ICH versus headache.
Figure 3
Figure 3
Forest plot of ICH versus vomiting.
Figure 4
Figure 4
Forest plot of ICH versus focal neurology.
Figure 5
Figure 5
Forest plot of ICH versus seizures.
Figure 6
Figure 6
Forest plot of ICH versus LOC.
See this image and copyright information in PMC

Comment in

  • Intracranial injury in minor head trauma.
    Kuppermann N. Kuppermann N. Arch Dis Child. 2004 Jul;89(7):593-4. doi: 10.1136/adc.2003.046821. Arch Dis Child. 2004. PMID: 15210483 Free PMC article. No abstract available.

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