The impact of previous head trauma and history of cranial surgery on clinical findings in acute pediatric head injury

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dc.contributor.authorKarakoyun, Salih
dc.contributor.authorSelki, Kudret
dc.contributor.authorKarakoyun, Ali R. I. Za
dc.contributor.authorBogan, Mustafa
dc.date.accessioned2026-07-01T11:40:04Z
dc.date.available2026-07-01T11:40:04Z
dc.date.issued2026
dc.departmentDüzce Üniversitesi
dc.description.abstractBackground: This study aimed to identify independent predictors of intracranial pathology in children presenting with acute blunt head trauma, with a particular focus on patients who had a history of previous head trauma or cranial surgery and did not meet the PECARN (Pediatric Emergency Care Applied Research Network) criteria for cranial computed tomography (CCT). The study further sought to evaluate the impact of these historical factors on acute clinical findings and to inform more objective decision-making for CCT use in this specific subgroup. Methods: In this prospective cohort study, indications for cranial computed tomography (CCT) were determined based on PECARN criteria. Demographic characteristics, trauma mechanism, mode of presentation, symptoms, physical examination findings, scalp hematoma characteristics, Glasgow Coma Scale (GCS) scores, and CCT findings were recorded for all patients. Subgroup analyses were performed based on previous head trauma and cranial surgery history. Results: Among 1495 enrolled patients, intracranial pathology (skull fracture and/or intracranial hemorrhage) was detected in 2.6% (n = 39) on CCT. Lower GCS (<= 14), arrival by ambulance, vomiting, and abnormal mental status were significantly associated with intracranial pathology (all p < 0.05). Temporal (OR: 16.35; 95% CI: 3.57-74.76; p < 0.001), parietal (OR: 10.38; p < 0.001), occipital (OR: 6.20; p = 0.008), and frontal (OR: 4.99; p < 0.001) scalp hematomas were independently associated with intracranial pathology. Younger age (OR: 0.83; p < 0.001) and lower GCS (OR: 0.67; p = 0.021) were also identified as independent risk factors for predicting intracranial injury. Among 361 patients (24.1%) with a history of head trauma and 16 patients (1.1%) with a history of cranial surgery, the rate of intracranial pathology was comparable to that of the general population (all p > 0.05). Conclusions: The PECARN clinical decision rule allows clinicians to safely avoid unnecessary cranial CT imaging in low-risk cases owing to its high sensitivity and negative predictive value. Furthermore, previous head trauma or a history of cranial surgery was not found to increase the risk of new-onset acute intracranial injury. (c) 2026 Elsevier Inc. All rights are reserved, including those for text and data mining, AI training, and similar technologies.
dc.identifier.doi10.1016/j.ajem.2026.01.005
dc.identifier.endpage26
dc.identifier.issn0735-6757
dc.identifier.issn1532-8171
dc.identifier.orcid0000-0002-3495-4991
dc.identifier.pmid41547130
dc.identifier.scopus2-s2.0-105027373332
dc.identifier.scopusqualityQ1
dc.identifier.startpage21
dc.identifier.urihttps://doi.org/10.1016/j.ajem.2026.01.005
dc.identifier.urihttps://hdl.handle.net/20.500.12684/23625
dc.identifier.volume102
dc.identifier.wosWOS:001673790900001
dc.identifier.wosqualityQ2
dc.indekslendigikaynakWeb of Science
dc.indekslendigikaynakScopus
dc.indekslendigikaynakPubMed
dc.language.isoen
dc.publisherW B Saunders Co-Elsevier Inc
dc.relation.ispartofAmerican Journal of Emergency Medicine
dc.relation.publicationcategoryMakale - Uluslararası Hakemli Dergi - Kurum Öğretim Elemanı
dc.rightsinfo:eu-repo/semantics/closedAccess
dc.snmzKA_WOS_20260623
dc.subject[Keyword Not Available]
dc.titleThe impact of previous head trauma and history of cranial surgery on clinical findings in acute pediatric head injury
dc.typeArticle

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