The journal of trauma and acute care surgery
January 29, 2026 · via Europe PMC
Does pneumocephalus affect the application of the pediatric brain injury guidelines?
Kahan AM, Kahan AM, Mahler KW, +10 more, Russell KW.
AI summary — for doctors, generated from the abstract only
In children with low- to moderate-risk blunt TBI, pneumocephalus was not associated with more neurosurgical intervention, progression or ICU admission.
What was studied
A retrospective cohort of 832 children with kBIG 0-2 blunt TBI at a level 1 pediatric trauma center (2018-2024), comparing those with and without pneumocephalus.
Key findings
- Pneumocephalus present in 143 patients (18.1%)
- Neurosurgical intervention 0.2% vs. 0.7%
- Injury progression 12% vs. 9.8%
- ICU admission 8.1% vs. 9.7%; ICU stay similar
Clinical relevance
Suggests pneumocephalus alone may not need to change kBIG classification, though rare outcomes limit power; Level IV data.
Who should care
Limitations
Single-centre retrospective study with very few neurosurgical events.
Pneumocephalus did not appear to add risk in children with otherwise low- to moderate-risk head injuries.
This is an AI-generated summary of the published abstract, not a clinical recommendation. It may not reflect the full text or subsequent updates — verify against the original source before acting on it.
Abstract
Background
The pediatric brain injury guidelines (kBIG) are a newly established clinical triage tool for managing pediatric traumatic brain injuries (TBIs). However, the kBIG classification does not include pneumocephalus, raising uncertainty about how to classify and manage patients with this finding. In this study, we sought to determine the risk of neurosurgical intervention, injury progression, and intensive care unit (ICU) admission in children with low- to moderate-risk TBIs and pneumocephalus.
Methods
We conducted a retrospective cohort study of pediatric trauma patients (younger than 18 years) after blunt mechanism trauma with an Abbreviated Injury Scale head score of >1 treated at a level 1 pediatric trauma center between January 2018 and April 2024. We applied the kBIG criteria to this cohort and excluded kBIG3 patients from the analysis. Demographics, presence of pneumocephalus, injury type, repeat head computed tomography, and neurosurgical intervention were extracted. Progression was defined as new or worsening bleed on repeat computed tomography. Neurosurgical treatment was defined as any operative intervention performed by a neurosurgeon.
Results
We included 832 pediatric trauma patients classified as kBIG0, kBIG1, and kBIG2 TBIs. Pneumocephalus was present in 143 patients (18.1%). There was no significant difference in neurosurgical intervention rates (0.2% vs. 0.7%; p = 0.5), injury progression (12% vs. 9.8%; p = 0.7), ICU admission 8.1% vs. 9.7%; p = 0.5), or ICU length of stay (1 [1-1] vs. 1 [1-1], p = 0.7) between patients with and without pneumocephalus.
Conclusion
In this study, we found that pneumocephalus is an uncommon finding in low- to moderate-risk blunt head injuries. Patients with pneumocephalus had no increased risk of neurosurgical treatment or injury progression compared with those without. These findings suggest that pneumocephalus does not confer additional clinical risk and may be safely excluded from consideration when applying the kBIG classification to guide management in otherwise low- to moderate-risk patients. ( J Trauma Acute Care Surg . 2026;101: 437-441. Copyright © 2026 Wolters Kluwer Health, LLC. All rights reserved.).
Level of evidence
Prognostic and Epidemiologic; Level IV.
DOI
10.1097/ta.0000000000004909
PMID
41609512
Research metadata (titles, abstracts, authors, publication dates) is sourced from Europe PMC, which aggregates content from PubMed/MEDLINE, PubMed Central, and other providers under the U.S. National Library of Medicine (NLM/NCBI). NLM does not claim copyright on abstracts; the original journal publishers or authors may hold rights to the full articles. AI-generated summaries are derived only from the abstract, never the full text, and are always labeled as AI-generated.
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