Validation of the Sainte-Justine Head Trauma Pathway for children younger than two years of age

Validation of the Sainte-Justine Head Trauma Pathway for children younger than two years of age

Can J Surg 2018;61(4):283-287 | PDF

Sarah Spénard; Serge Gouin, MDCM; Marianne Beaudin, MD; Jocelyn Gravel, MD, MSc

Summary

The Sainte-Justine Head Trauma Pathway helps physicians’ decision-making in the evaluation of head trauma in young children. We evaluated the pathway to identify clinically important traumatic brain injury (ciTBI) among children younger than two years who presented to a pediatric emergency department for a head trauma. The primary outcome was ciTBI, defined as a TBI complicated by death, neurosurgery, intubation or hospitalization for more than one night. Among 2258 children, we reviewed the charts of all hospitalized children (n = 100) and a random sample of nonhospitalized children (n = 101) and found a ciTBI in 26 patients. The Sainte-Justine Head Trauma Pathway and the Pediatric Emergency Care Applied Research Network Pediatric Head Injury Prediction Rule both had a sensitivity of 96% (95% confidence interval 81%–100%). We found that the Sainte-Justine Head Trauma Pathway does not improve the identification of ciTBI among young children with head trauma.


Partial results of this study were presented at the International Conference on Emergency Medicine (Cape Town, South Africa) in April 2016, the Pediatric Academic Societies conference (Baltimore, USA) in May 2016 and the Canadian Association of Emergency Physicians conference (Québec, Canada) in June 2016.

Accepted Dec. 6, 2017

Affiliations: From the Université de Montréal, Montréal, Que. (Spénard, Gouin, Beaudin, Gravel); the Department of Pediatrics, Division of Pediatric Emergency Medicine, CHU Sainte-Justine, Université de Montréal, Montréal, Que. (Gouin, Gravel); and the Department of Surgery, Division of Pediatric Surgery, CHU Sainte-Justine, Université de Montréal, Montréal, Que. (Beaudin).

Competing interests: None declared.

Contributors: All authors contributed substantially to the conception, writing and revision of this article and approved the final version for publication.

DOI: 10.1503/cjs.013217

Correspondence to: J. Gravel, Section d’Urgence, Département de Pédiatrie, CHU Sainte-Justine, 3175 Chemin Côte Sainte-Catherine, Montréal QC H3T 1C5, graveljocelyn@hotmail.com