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Use of white cell count, age, and presence of other injuries in stratifying risk of intracranial injury in pediatric trauma
  1. Margo A Peyton1,
  2. Theodore Kouo2,
  3. Jennifer Scott2,
  4. Lisa R Yanek3,
  5. Thuy L Ngo2
  1. 1 Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
  2. 2 Division of Pediatric Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
  3. 3 Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
  1. Correspondence to Margo A Peyton, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA 21205; mpeyton6{at}


The Pediatric Emergency Care Applied Research Network (PECARN) Head Injury/Trauma Algorithm is a well-validated decision rule used to identify patients at low risk of clinically important traumatic brain injuries who may not need head CT. In adult patients with mild head trauma, elevated serum glucose and white cell count (WCC) have been associated with abnormal head CT findings. Currently, glucose or WCC is not considered in pediatric patients. The objective of this study was to determine if elevations in glucose or WCC could be used as additional tools to risk-stratify pediatric trauma patients for intracranial injury (ICI). Data were abstracted from the Maryland Trauma Registry and from electronic medical records for patients at the Johns Hopkins Children’s Center from 2017 to 2020. We evaluated 145 encounters that met the inclusion criteria. There were 33 cases of ICI on CT. In addition to higher median glucose and WCC, we found that patients with ICI had a younger median age and were less likely to have other clinically significant injuries than patients without ICI. Following multiple logistic regression analysis, WCC (OR 1.113, 95% CI 1.02 to 1.21), younger age (OR 0.89, 95% CI 0.8 to 0.98), and absence of other injuries (OR 0.41, 95% CI 0.23 to 0.73) were found to be associated with risk of ICI. The area under the curve for our model was 0.79. When used with the PECARN algorithm, our model could help determine which patients may avoid head CT or undergo a shorter observation period.

  • craniocerebral trauma
  • emergency service
  • hospital
  • leukocyte count

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  • Contributors TLN, TK, JS, and MAP collected the data. TK and LRY performed the statistical analysis. TLN, TK, and MAP wrote and revised the manuscript. All authors reviewed the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The Johns Hopkins School of Medicine Institutional Review Board approved this study (IRB00220918).

  • Provenance and peer review Not commissioned; externally peer reviewed.

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