Table 2.

Predictors for ICI

First AuthorYearDesignEligibility CriteriaN <2 YearsRisk Factors for ICI
Schunk231996Retrospective cohortAge <18 with CT for HT, GCS = 15, nonfocal neuro 96 6 ICISkull fracture NOT predictive: LOC, vomiting, seizure, sleepiness
Quayle81997Prospective cohortAge <18, nontrivial HT, CT, and SR134 7 ICISF, focal neuro, young age (particularly <3 mo) symptoms: 6/7 alert/nonfocal; 5/6 no symptoms, only scalp findings and SF
Greenes211999Prospective cohortChildren <2 evaluated in ED for HT608 30 ICIParietal swelling, h/o lethargy or altered MS on exam, unclear mechanism of injury, SF, young age (<6 mo); ANY sign or symptom: sensitivity = 0.52 specificity = 0.72 NOT predictive: vomiting, LOC (80% of patients with ICI were alert and active or alert but quiet; 16% fell <3 ft)
Ramundo201995Retrospective cohort<19 with HT and CT; (76% GCS = 15) 37Abuse, depressed SF, focal motor abnormality, anisocoria NOT predictive: LOC, vomiting, seizure, MVC
Gruskin191999Retrospective cohort<2 evaluated in ED for HT278 12 ICIAge <12 mo, fall >3 ft, focal neuro, GCS <15, scalp abnormality NOT predictive: LOC, vomiting, seizure, behavior change. Of note: 75% were alert with nonfocal neuro
Duhaime281992Prospective cohortChildren <2 admitted with HT100 25 ICIMVC (P < .0002) inflicted injury (P < .0002)
Shane241993Case seriesAge ≤1 alert, admitted with SF102 ≤1 15 ICITemporal SF, lethargy (either before or in ED; only 47% sensitive) presence of ANY sign or symptom was 100% sensitive and 35% specific (include LOC, seizure, vomiting, altered MS or behavior, focal neuro)
Bonadio331989Case seriesPediatric patients with parietal SF who had CT 52 <1 20 ICI17/20 had 1 or more of following: LOC/altered MS, abnormal neuro, complicated SF; of the other 3, 2 were <6 wk without symptoms
Dietrich141993Prospective cohort<21 with CT for HT 71; 3 with ICI (2 GCS = 15)Of 3: 1 with LOC, 1 focal neuro, 1 GCS ≤14
Schuynoll341993Prospective cohortCT for HTN <2 y not noted4 patients <2 had fallen and had signs suspicious for SF but were otherwise acting appropriately
  • GCS indicates Glasgow Coma Score; neuro, neurologic examination; ED, emergency department; MVC, motor vehicle collision; MS, mental status.