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Brain Injuries, TraumaticSHIPPNCT05964764

Validation of the Scandinavian Guidelines for Minor and Moderate Head Trauma in Children

An observational study of Brain Injuries, Traumatic, run by Halmstad County Hospital at 16 sites in 2 countries.

Recruiting

Looking for participants now. Contact the study team or a site below to ask about taking part.

Sites and contacts
Official record
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Trial summary

Head injuries are common among children and adolescents, with many of them assessed in emergency departments each year. Most children recover fast, with full resolution of symptoms as headache, dizziness or fatigue. A few, however, develop life-threatening complications (such as bleedings in/around the brain). Read more about this study

Who is it for?
Ages Up to 17 years
Conditions the study is for
Brain Injuries, Traumatic
How many people
5,300 participants
Where
16 sitesin 2 countries
Study dates
1 Apr 2018to 31 Dec 2029
How long will I take part?
4 Months
Phase
Observational
Are there results?
Not yet: the study is under way

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages Up to 17 years
  • All sexes
  • No healthy volunteers
  • Child

Study population: Target population is children in Scandinavia with recent minor and moderate head trauma seeking care on emergency departments within participating in study.

Who may be able to join

  • Age <18 years.
  • Minor and moderate blunt head trauma (GCS 9 - 15) seeking medical assessment in an emergency department at a study hospital in Sweden or Norway.
  • Within 24 hours of trauma.
  • Informed oral consent from one guardian, and child if older than 14 years old, after receiving oral and written information about study.

Who cannot join

  • Patient and/or guardian does not wish to participate in the study.
  • Patient included in other study that may affect the management/treatment in the emergency department.
  • Penetrating head injury (as those will always receive a CT scan).
  • Suspected child abuse / non-accidental trauma (NAT) denoted as suspected child abuse where the social services are informed (as they will always receive a CT scan).
  • The patient is not a citizen in the participating country and hence difficult to follow up.

Trial locations and contacts

16 sites in 2 countries. Contact the study team or a site near you to ask about taking part.

16 sites in 2 countries

Sweden15 sites, 11 recruiting
  • Alingsås Lasarett

    Alingsås

    Hanna Farahnoosh, MD

    Recruiting
  • Mälarsjukhuset i Eskilsstuna

    Eskilstuna

    Active, not recruiting
  • Drottning Silvias Barnsjukhus

    Gothenburg

    Sarah Thornberg, MD

    Recruiting
  • Halland Hospital Halmstad

    Halmstad

    Fredrik Wickbom, MD, 004635131000, fredrik.wickbom@regionhalland.se

    Recruiting
  • Länssjukhuset Ryhov

    Jönköping

    Active, not recruiting
  • Lasarettet i Ljungby

    Ljungby

    Malin Johansson, MD

    Recruiting
  • Skåne University Hospital, Lund

    Lund

    Jorge Sotoca Fernandez, MD

    Recruiting
  • Skånes Universitetssjukhus Malmö

    Malmö

    Jorge Sotoca Fernandez, MD

    Recruiting
  • Mora Lasarett

    Mora

    Anders Santoft, MD

    Recruiting
  • Örebro Universitetssjukhus

    Örebro

    Terminated
  • Astrid Lindgren Childrens Hospital, Solna

    Stockholm

    Kristofer Kjellröier, MD

    Recruiting
  • Norra Älvsborgs Länssjukhus

    Trollhättan

    Completed
  • Norrland University Hospital, NUS

    Umeå

    Beatrice Magnusson, MD, PhD

    Recruiting
  • Halland Hospital Varberg

    Varberg

    Rasmus Silfver, MD

    Recruiting
  • Ystad Lasarett

    Ystad

    Rachel Keeling, MD

    Recruiting

Other trials in Sweden

Norway1 site, 1 recruiting
  • Haukeland Universitetssjukehus

    Haukeland

    Aqeel Chaudhry, MD

    Recruiting

Other trials in Norway

About this study

Official title: A Pragmatic, Prospective, Multicentre Study for the Validation of the Scandinavian Guidelines for Minor and Moderate Head Trauma in Children

Head injuries are common among children and adolescents, with many of them assessed in emergency departments each year. Most children recover fast, with full resolution of symptoms as headache, dizziness or fatigue. A few, however, develop life-threatening complications (such as bleedings in/around the brain). It can be difficult to swiftly and accurately identify these patients in the emergency department. To aid in this task, decision support tools has been developed.

The goal of this observational study is to evaluate a Scandinavian tool developed to aid in management of children with head injuries seeking care in an emergency department.

Read more

The main research question is:

  • Are the Scandinavian guidelines for management of mild and moderate head trauma in children sensitive for patient-important outcomes?

Patients will be given the same treatment and recommendations for their head injury no matter if they participate or not in the study, as there is no intervention/ treatment group.

The doctor or nurse managing the child will collect information on patient history, signs and symptoms in the emergency department and management in an electronic case report form. Information on how the recovery period is collected both from medical records >1 month after the emergency department visit, as well as via electronic questionnaires sent to the guardian at 1 month, 3 months and 4 months after the injury via e-mail and/or text message. Long-term outcome will also be examined (>6 months).

Read the detailed description

Design:

This is a pragmatic, prospective, multicentre, observational study of children presenting with mild or moderate traumatic brain injury (TBI) in a general or paediatric emergency department (ED) at hospitals in Scandinavia. A complete data set for analysis including predictor variables and outcome data for the six guidelines included in the study will be registered (SNC2016, PECARN, CATCH, CHALICE, PREDICT, NICE23). There are no interventions as the study is observational. Attending physicians and nurses are instructed to manage children in accordance with the hospital's ordinary guidelines and follow local treatment traditions.

Study setting and population:

The study will be set in Sweden and Norway. Hospitals with different trauma capacities will participate; invitations are sent to units which on daily basis mange children with TBI in their department. Efforts are made to establish a representative distribution in participating centres. The coordinating centre is Halmstad Hospital in southern Sweden.

Data registration and follow-up:

Information on management in the emergency department including patient characteristics, injury type and mechanism, patient history, clinical examination results and current medications will be prospectively documented in a web- based case-report form by the triage nurse and/or physician on call.

One month after trauma, the local study coordinator will assess medical records and journals, screening for outcome measures as well as CT findings, when applicable. A follow-up questionnaire will be sent to guardian(s) 1 month, 3 months and 4 months after the child ́s head injury via e-mail and/or text message (long-term follow up at >6 months). Reminders will be re-sent if no answer is received, primarily by e-mail and then twice by text message.

All data will be registered in via web-based case report forms in Entermedic (Entergate AB). Pseudo-anonymized data will be extracted from database and imported to IBM SPSS® Statistics software version 28 for statistical analysis.

Biomarkers:

A sub-study on patients with intermediate risk for intracranial injury and GCS 14-15, in selected study centres will explore biomarkers as predictors for intracranial injury. Venous blood, capillary blood and saliva sample is sampled from the patient in the ED after written informed consent. Sampling is done within 12 hours from the time of the injury. Analysis of biomarker S100B and others, not yet specified, will be analysed in batch at end of sub-study period.

CT examinations:

CT scans are analysed by a board-certified radiologist on the centre where the exam is performed.

Statistics:

The accuracy of the (SNC) guidelines to predict the primary endpoint will be assessed by 95% confidence intervals (CI) for sensitivity, specificity, likelihood ratio, negative predictive value (NPV) and positive predictive value (PPV). Test performance for other internationally recognized clinical decision rules (PECARN, CATCH, CHALICE, NICE, PREDICT) will also be calculated both in application cohorts (defined by each rule specific inclusion and exclusion criteria) and in comparative cohorts (minor head injury cohort = all patients with GCS 13-15; all patient cohort). When assessing CDRs other than SNC16, both rule specific endpoints and in-study defined endpoints will be tested. Secondary endpoints will be assessed using the same methods. Biomarker analysis results in ROC curves for sensitivity / specificity and from these are specific cut-offs that maximize performance for negative predictive value (i.e., to avoid unnecessary CT examinations and/or admission) derived.

Sample size:

The investigators aim to include 5,300 children, but not more than more than 4 years of active enrolment.

Ethics:

Ethical approval was granted from the Regional Ethical Review Board in Lund (approval number 2017/238) and Ethical Review Board in Norway (approval number 1085). Informed verbal consent will be obtained and registered. Patients' data and social security number will be stored and handled accordingly to European Union General Data Protection Regulation (GDPR 2016/679) and applicable Swedish laws.

A detailed protocol describing study methodology and statistical methods will be published before end of inclusion.

Medical subject headings
Brain Injuries, Traumatic

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Number of participants with "clinically important intracranial injury (CIII)"

    Defined as a composite variable of death, neurosurgery, admission to hospital ward two (2) days or more due to head injury or intubation one (1) day or more due to pathological traumatic CT findings.

    Measured: Within 1 week of injury.

Secondary outcomes (24)
  1. Number of participants with death due to head injury

    Defined as death as consequence of the TBI

    Measured: Within one week; within 3 months.

  2. Number of participants with neurosurgery due to TBI

    Defined as need for any neurosurgical procedure or intervention, including sedation and intubation with controlled ventilation for non-surgical injuries such as diffuse axonal injury.

    Measured: Within 1 week of injury.

  3. Number of participants with CT findings

    Defined as a possibly trauma-related intracranial finding on CT-scan, such as cranial fractures or acute intracranial haemorrhage.

    Measured: Within 1 week of injury.

  4. Number of participants with significant CT findings

    Defined as a possibly trauma-related intracranial finding on CT-scan, such as cranial fractures or acute intracranial haemorrhage, but not including undislocated skull fractures

    Measured: Within 1 week of injury.

  5. Concentration of specific biomarkers in serum and saliva

    Biomarker concentration (S-100B, GFAP, UCH-L1, NSE, tau, NF(H and L), H-FABP, SNTF, MBP, miRNAs, IL-10, BTP, SBDP145, MMP9, HGF, IL-6, OPN, SAA, SICAM, leptin, copeptin, fibrinogen, d-dimer, ICAM, VCAM, IL-12, eotaxin, TNFR2 in a group of patients with TBI and GCS 14-15 in ED.

    Measured: Sampling at admission to the emergency department

  6. Number of participants admitted to in-hospital observation > 2 days

    Admission to a hospital ward two (2) days or more due to TBI.

    Measured: Within 3 months from injury

  7. Number of participants admitted to in-hospital observation

    Admission to a hospital ward due to TBI, irrespective of duration of observation

    Measured: Within 3 months from injury

  8. Number of participants with extended "clinical observation in ED"

    Prolonged clinical observation in ED due to TBI

    Measured: Within the first day (24 hours) of injury

  9. Duration of clinical observation

    Duration of clinical observation (time in ED or time in ED and in-hospital ward)

    Measured: Within 1 week of injury.

  10. Number of participants intubated due to TBI

    Endotracheal intubation due to TBI

    Measured: Within 3 months from injury

  11. Duration of intubation due to TBI

    Duration of intubation categorised as <6h, 6-12 h, 13-24h, 25-48 h, 49h-1 week and >1 week.

    Measured: Within 3 months from injury

  12. Number of participants referred for cranial CT (cCT) due to head injury.

    Referred for cCT due to head injury

    Measured: Within 3 months from injury

  13. Number of participants referred for a follow up (re-)cCT due to clinical deterioration.

    Referred for re-cCT due to clinical deterioration.

    Measured: Within 3 months from injury

  14. Number of participants referred for a cCT due to clinical deterioration during prolonged observation (in ED or on ward).

    Referred for (primary) cCT due to clinical deterioration during prolonged clinical observation.

    Measured: Within 3 months from injury

  15. Number of participants with need for sedation or intubation during cCT exam

    All ages and stratified 0-4 years, 5-14 years and >14 years. Sedation is defined as positive if participant has received a sedative agent (for example propofol or midazolam) during CT scan.

    Measured: Within 3 months from injury

  16. Number of participants with presence of outcome as defined by CATCH-rule ("need for neurological intervention" or "brain injury on CT" )

    Need for neurological intervention is defined as either death within 7 days secondary to the head injury or need for any of the following procedures within 7 days: craniotomy, elevation of skull fracture, monitoring of intracranial pressure, or insertion of an endotracheal tube for the management of head injury.

    Brain injury on CT defined as any acute intracranial finding revealed on CT that was attributable to acute injury, including closed depressed skull fracture.

    Measured: Within one week from trauma

  17. Number of participants with presence of outcome as defined by PECARN-rule ("clinically important TBI").

    Clinically important TBI is defined as death from TBI, neurosurgical intervention for TBI (intracranial pressure monitoring, elevation of depressed skull fracture, ventriculostomy, haematoma evacuation, lobectomy, tissue debridement, dura repair, or other), intubation of more than 24 h for TBI or hospital admission of 2 nights or more for TBI in association with TBI on CT.

    Measured: Within one week from trauma

  18. Number of participants with presence of outcome as defined by CHALICE-rule ("clinically significant intracranial injury" or "presence of skull fracture" or "admission to hospital").

    Clinically significant intracranial injury is "defined as death as a result of head injury, requirement for neurosurgical intervention, or marked abnormality on CT.

    Measured: Within one week from trauma

  19. Number of participants with presence of outcome as defined by PREDICT-rule ("clinically important intracranial injury in need for intervention").

    Clinically important intracranial injury in need for intervention is defined as neurosurgery and/or intensive care due to TBI.

    Measured: Within one week from trauma

  20. Number of participants with presence of outcome as defined by NICE23-rule ("clinically important traumatic brain injury")

    Clinically important traumatic brain injury is assumed to be the same as in PECRAN, hence defined as death from TBI, neurosurgical intervention for TBI (intracranial pressure monitoring, elevation of depressed skull fracture, ventriculostomy, haematoma evacuation, lobectomy, tissue debridement, dura repair, or other), intubation of more than 24 h for TBI or hospital admission of 2 nights or more for TBI in association with TBI on CT.

    Measured: Within one week from trauma

  21. Number of participants reassessed or readmitted due to TBI

    Reassessed and sent home from ED, or admitted from ED after reassessment due to prior TBI.

    Measured: Within four weeks from trauma

  22. Number of participants transported to other hospital due to TBI

    Transport to other hospital due to TBI, irrespective of cause or way of transportation.

    Measured: Within 3 months from injury

  23. Time to full recovery

    Time to full recovery from TBI

    Measured: <1 week, 1 week, 2 weeks, 3 weeks, 1 month, 2 months, 3 months, not recovered at 3 months

  24. Clinicial utility SNC16 rule

    Experienced utility of the SNC16-rule when applied hypothetically on the participating child with TBI, by the managing doctor. Assessed on a 7-step Likert scale.

    Measured: At admission to the emergency department.

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted28 Jul 2023
  2. Study start1 Apr 2018
  3. Primary completion31 Aug 2024 (estimated)
  4. Study completion31 Dec 2029 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Observational
Observational model
Cohort
Time perspective
Prospective
Enrolment
5,300 participants (estimated)
Target duration
4 Months
IDs, dates and publications
ClinicalTrials.gov ID
NCT05964764
Sponsor's protocol ID
220871
Acronym
SHIPP
Status last verified
Feb 2024
First submitted
22 Jun 2023
Last updated
28 Feb 2024
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Yes: Sharing of de-identified data for all primary and secondary outcome measures will be considered on individual basis after main and secondary analysis has been completed.

Publications

  • Wickbom F, Thornberg S, Sotoca Fernandez J, Silfver R, Marklund N, Unden J; Scandinavian Neurotrauma Committee. Comparison of predictive tools for management of paediatric mild TBI: a prospective cohort study. EClinicalMedicine. 2025 Sep 9;88:103484. doi: 10.1016/j.eclinm.2025.103484. eCollection 2025 Oct.

    PubMed 40979218
  • Wickbom F, Calcagnile O, Marklund N, Unden J. Validation of the Scandinavian guidelines for minor and moderate head trauma in children: protocol for a pragmatic, prospective, observational, multicentre cohort study. BMJ Open. 2024 Apr 3;14(4):e078622. doi: 10.1136/bmjopen-2023-078622.

    PubMed 38569695

Questions about this trial

What is this clinical trial studying?

An observational study of Brain Injuries, Traumatic, run by Halmstad County Hospital at 16 sites in 2 countries.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 4 inclusion and 5 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: looking for participants now, as of the sponsor's last update on 28 Feb 2024. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 16 sites in Sweden, Norway. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

This study is still under way. Results are not available in the source record yet.

How can a doctor refer a patient or contact the research team?

Contact Fredrik Wickbom, MD (004635131000, fredrik.wickbom@regionhalland.se), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Number of participants with "clinically important intracranial injury (CIII)" (time frame: Within 1 week of injury.). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT05964764, which also lists 2 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 28 Feb 2024.

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