TABLE 2.
Necessity of SS for Children <24 Months Old Presenting With ICH
| Caregiver-Reported Historya | Clinical Presentation | Age, mo | ||
|---|---|---|---|---|
| <6 | 6–11 | 12–23 | ||
| Tiny extra-axial hemorrhage directly under skull fracture | ||||
| None | External signs of head trauma and clinically well appearing | N | N | N |
| Short fall | Clinically well appearing | N | N | U |
| High fall | Clinically well appearing | N | U | U |
| Crush injury | Clinically well appearing | N | N | U |
| EDH | ||||
| None | External signs of head trauma and clinically well appearing | N | N | U |
| Non-specific signsb | N | N | N | |
| Clinically ill with signs of CNS injuryc | N | N | N | |
| Short fall | Clinically well appearing | N | N | U |
| Clinically ill with signs of CNS injuryc | N | N | N | |
| High fall | Clinically well appearing | N | U | U |
| Clinically ill with signs of CNS injuryc | N | N | U | |
| Crush injury | Clinically well appearing | N | N | U |
| Clinically ill with signs of CNS injuryc | N | N | U | |
| SDH | ||||
| None | External signs of head trauma and clinically well appearing | N | N | N |
| Non-specific signsb | N | N | N | |
| Clinically ill with signs of CNS injuryc | N | N | N | |
| Short fall | Clinically well appearing | N | N | N |
| Clinically ill with signs of CNS injuryc | N | N | N | |
| High fall | Clinically well appearing | N | N | N |
| Clinically ill with signs of CNS injuryc | N | N | N | |
| Crush injury | Clinically well appearing | N | N | N |
| Clinically ill with signs of CNS injuryc | N | N | N | |
Summary of panelists’ ratings on clinical scenarios related to presentations of children <24 mo old presenting with ICH. SS was rated as one of the following for each scenario: appropriate but not necessary, inappropriate, uncertain whether appropriate or not, appropriate and necessary, or appropriate but uncertain whether necessary. All scenarios were deemed either uncertain whether appropriate or not (U) or appropriate and necessary (N) by the panelists. CNS, central nervous system.
In the scenarios presented in the first column, history of trauma explaining the ICH is provided as none (no history provided); short fall <3 feet (eg, off of couch); high fall ≥3 feet (eg, off of high chair); crush injury (eg, TV falling on child).
Examples of non-specific signs included irritability and/or emesis.
Examples of signs of CNS injury included apnea and/or seizures.