Factors associated with traumatic brain injury in children younger than 2 years undergoing computed tomography more than 24 hours after head trauma

Purpose: Current clinical decision rules for pediatric head computed tomography (CT) are primarily based on patients presenting within 24 hours of injury.Evidence regarding children who present after more than 24 hours of head trauma remains limited.We aimed to identify risk factors for CTconfirmed traumatic brain injury (CT-TBI) in young children who presented to emergency departments (EDs) over 24 hours after head trauma.Methods: We retrospectively reviewed medical records of children younger than 24 months who presented over 24 hours after injury and underwent CT at 2 EDs in Seoul, South Korea, from 2011 through 2021.Logistic regression analysis was used to assess factors associated with the occurrence of CT-TBI.Results: A total of 79 children were included: those without CT-TBI (n = 29) and those with (n = 50).Sex and age category (0-11 vs. 12-23 months) did not differ between the groups.The median time to ED visit was longer in the children with CT-TBI (60.4 hours [interquartile range, 34.2-77.8]vs. 91.8hours [59.3-148.1];P = 0.003).This group showed higher proportions of falls from a height greater than 0.9 m (3.4% vs. 22.0%;P = 0.047) and of non-frontal scalp hematoma (31.0% vs. 92.0%;P <0.001).In the logistic regression, non-frontal scalp hematoma was the sole factor independently associated with CT-TBI (adjusted odds ratio, 71.43 [95% confidence interval, 4.79-1,064.48]).Applying the Pediatric Emergency Care Applied Research Network rule to the population, sensitivity and negative predictive value were both 100% for clinically important traumatic brain injury and 96.0% and 83.3%, respectively, for CT-TBI.Conclusion: Among children younger than 2 years who presented to the EDs more than 24 hours after injury and underwent CT, the presence of non-frontal scalp hematoma was associated with the occurrence of CT-TBI.