Research Article
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Published Online: 1 November 2018

Development of the CIDSS2 Score for Children with Mild Head Trauma without Intracranial Injury

Publication: Journal of Neurotrauma
Volume 35, Issue Number 22


While most children with mild traumatic brain injury (mTBI) without intracranial injury (ICI) can be safely discharged home from the emergency department, many are admitted to the hospital. To support evidence-based practice, we developed a decision tool to help guide hospital admission decisions. This study was a secondary analysis of a prospective study conducted in 25 emergency departments. We included children under 18 years who had Glasgow Coma Scale score 13–15 head injuries and normal computed tomography scans or skull fractures without significant depression. We developed a multi-variable model that identified risk factors for extended inpatient management (EIM; defined as hospitalization for 2 or more nights) for TBI, and used this model to create a clinical risk score. Among 14,323 children with mTBI without ICI, 20% were admitted to the hospital but only 0.76% required EIM for TBI. Key risk factors for EIM included Glasgow Coma Scale score less than 15 (odds ratio [OR] = 8.1; 95% confidence interval [CI] 4.0–16.4 for 13 vs. 15), drug/alcohol Intoxication (OR = 5.1; 95% CI 2.4–10.7), neurological Deficit (OR = 3.1; 95% CI 1.4–6.9), Seizure (OR = 3.7; 95% CI 1.8–7.8), and Skull fracture (odds ratio [OR] 24.5; 95% CI 16.0–37.3). Based on these results, the CIDSS2 risk score was created. The model C-statistic was 0.86 and performed similarly in children less than (C = 0.86) and greater than or equal to 2 years (C = 0.86). The CIDSS2 score is a novel tool to help physicians identify the minority of children with mTBI without ICI at increased risk for EIM, thereby potentially aiding hospital admission decisions.

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Information & Authors


Published In

cover image Journal of Neurotrauma
Journal of Neurotrauma
Volume 35Issue Number 22November 15, 2018
Pages: 2699 - 2707
PubMed: 29882466


Published in print: November 15, 2018
Published online: 1 November 2018
Published ahead of print: 29 August 2018
Published ahead of production: 8 June 2018


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Jacob K. Greenberg [email protected]
Department of Neurological Surgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri.
Yan Yan
Department of Surgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri.
Christopher R. Carpenter
Division of Emergency Medicine, Washington University School of Medicine in St. Louis, St. Louis, Missouri.
Angela Lumba-Brown
Department of Emergency Medicine, Stanford University, Stanford, California.
Martin S. Keller
Department of Surgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri.
Jose A. Pineda
Department of Pediatrics, Washington University School of Medicine in St. Louis, St. Louis, Missouri.
Department of Neurology, Washington University School of Medicine in St. Louis, St. Louis, Missouri.
Ross C. Brownson
Department of Surgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri.
Alvin J. Siteman Cancer Center, Washington University School of Medicine in St. Louis, St. Louis, Missouri.
Prevention Research Center, Washington University School of Medicine in St. Louis, St. Louis, Missouri.
David D. Limbrick
Department of Neurological Surgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri.


Address correspondence to: Jacob K. Greenberg, MD, MSCI, St. Louis Children's Hospital, Washington University School of Medicine, One Children's Place, Suite 4S20, St. Louis, MO 63110 [email protected]

Author Disclosure Statement

No competing financial interests exist.

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