Does an Isolated History of Loss of Consciousness or Amnesia Predict Brain Injuries in Children After Blunt Head Trauma?

ABSTRACT. Background. A history of loss of con-sciousness (LOC) is frequently used as an indication for cranial computed tomography (CT) in the emergency de-partment (ED) evaluation of children with blunt head trauma. Objective. We sought to determine whether an isolated LOC and/or amnesia is predictive of traumatic brain in-jury (TBI) in children with blunt head trauma. Methods. We prospectively enrolled children <18 years old presenting to a level I trauma center ED be-tween July 1998 and September 2001 with blunt head trauma. We evaluated the association of LOC and/or am-nesia with 1) TBI identified on CT and 2) TBI requiring acute intervention. We defined the latter by a neurosur-gical procedure, antiepileptic medication for>1 week, persistent neurologic deficits, or hospitalization for>2 nights. We then investigated the association of LOC and/or amnesia with TBI in those patients without other symptoms or signs of TBI (“isolated ” LOC and/or amne-sia). Results. Of eligible children, 2043 (77%) were enrolled, 1271 (62%) of whom underwent CT; 1159 (91%) of these 1271 had their LOC and/or amnesia status known. A total of 801 (39%) of the 2043 enrolled children had a docu-mented history of LOC and/or amnesia. Of the 745 with documented LOC and/or amnesia who underwent CT, 70 (9.4%; 95 % confidence interval [CI]: 7.4%, 11.7%) had TBI identified on CT versus 11 of 414 (2.7%; 95 % CI: 1.3%, 4.7%) without LOC and/or amnesia (difference: 6.7%; 95 % CI: 4.1%, 9.3%). Of the 801 children known to have had LOC and/or amnesia (regardless of whether they underwent CT), 77 (9.6%; 95 % CI: 7.7%, 11.9%) had TBI requiring acute intervention versus 11 of 1115 (1%; 95