Factors affecting worsening intracranial injuries in pediatric patients with mild traumatic brain injury

Purpose:The clinical utility of routine repeat computed tomography (CT) in pediatric patients with mild traumatic brain injury (TBI) remains controversial.We aimed to identify factors associated with worsening intracranial injury (ICI) on repeat CT in pediatric patients with mild TBI.Methods: This retrospective study included patients aged 0-18 years with mild TBI (Glasgow Coma Scale score 13-15) who presented to an emergency department in South Korea from January 2017 through December 2023.Patients were included if they underwent an initial CT within 24 hours of injury and a repeat CT within 72 hours.Worsening ICI was defined as an increase in hemorrhage size or the development of new lesions on repeat CT.Clinical characteristics, injury mechanisms, and CT findings were compared between patients with and without the worsening ICI.Multivariable logistic regression was performed to identify independent predictors of worsening ICI on repeat CT.Results: A total of 212 patients were included, of whom 48 (22.6%) showed worsening ICIs on repeat CT (i.e., worsening group).The worsening group showed higher median values of age and length of hospital stay, as well as higher percentages of initial Glasgow Coma Scale of 14, motorcycle/bicycle injury, intensive care unit hospitalization, and abnormalities on initial CT (including skull fracture, epidural hemorrhage, subdural hemorrhage, and pneumocephalus), compared with their counterparts.The regression model showed subdural hemorrhage (odds ratio, 4.99 [95% confidence interval, 2.08-11.96]),epidural hemorrhage (4.04 [1.73-9.44]),and motorcycle/bicycle as the injury mechanism (2.94 [1.14-7.59])as the predictors. Conclusion:In pediatric mild TBI, motorcycle/bicycle accidents and the presence of hemorrhages on initial CT may be associated with worsening ICI on repeat CT.These findings support a riskstratified approach, in which repeat imaging is selectively considered for high-risk patients to reduce unnecessary radiation exposure.