Araştırma Makalesi
BibTex RIS Kaynak Göster

The Role of Computerized Tomography for the Evaluation of Head Trauma in Children

Yıl 2018, Cilt: 10 Sayı: 3, 294 - 297, 23.10.2018
https://doi.org/10.18521/ktd.434957

Öz

Objective: Head trauma is the cause of the most common reasons for pediatric emergency admissions. The decision for computerized tomography evaluation after minör head trauma is a challenge for children in nonverbal age.  This study aims to draw attention to unnecessary cranial computerized tomography scanning in children under two years of age.

Methods: The records of 183 head trauma cases between the ages of 0-24 months and between January 2011 and December 2015 were reviewed retrospectively. Results: Of the 183 patients included in the study, 93 were male (50.8%), 90 were female (49.2%), and the mean age of the patients was 13.08 ± 6.30 months (the youngest 1 months-of-age, the oldest 24 months-of-age). The distribution of the causes of the head trauma was as follow 139 (76%) accidental, 24 (13,1%) non-vehicle traffic accidents and 20 (10,9%) traffic accidents occurred. Cranial computerized tomography was performed in 80% of the cases. Moreover, was not in 12% of the cases. Patients with cranial computerized tomography had 7% (3.8%) of the frontal bone, 1 (0.5%) temporal bone, 5 (2.7%) occipital bone, and 5 (2.7%) parietal a bone fracture was detected. The duration of hospitalization was 0.54 ± 2.90 (min 0, max 27) days. None of the cases required an operation.

Conclusion: In children under two years of age, the height of computerized tomography withdrawal in head trauma was remarkable. This study emphasizes the necessity of putting the right indications for computerized tomography prompting, especially those with mild head trauma, and reducing the need for more detailed and objective criteria. 

Kaynakça

  • 1-Brenner DJ, Hall EJ. Computed tomography--an increasing source of radiation exposure. N Engl J Med 2007;357(22):2277-84.
  • 2-Schonfeld D, Fitz BM, Nigrovic LE. Effect of the duration of emergency department observation on computed tomography use in children with minor blunt head trauma. Annals of emergency medicine 2013;62(6):597-03.
  • 3-Wing R, James C. Pediatric head injury and concussion. Emerg Med Clin North Am 2013;31(3):653-75.
  • 4-Büyükcam F, Kaya U, Karakılıç ME. ve ark. Predicting the outcome in children with head trauma: comparison of FOUR score and Glasgow Coma Scale. Ulus Travma Acil Cerrahi Derg 2012;18(6):469-73.
  • 5-Demir ÖF, Aydın K, Turan F ve ark. Analysis of pediatric forensic cases presented to emergency department. Turk Arch Ped 2014;49(4):235-40.
  • 6-Işik HS, Gökyar A, Yildiz Ö. ve ark. Çocukluk çağı kafa travmaları, 851 olgunun retrospektif değerlendirilmesi: Epidemiyolojik bir çalışma. Ulus Travma Acil Cerrahi Derg 2011;17(2):166-72.
  • 7-Medwid K, Couri GG. How accurate are clinical decision rules for pediatric minor head injury? Ann Emerg Med 2012;60(3):278-9.
  • 8- Alharthy N, Al Queflie S, Alyousef K, et al., Clinical manifestations that predict abnormal brain computed tomography (CT) in children with minor head injury. Journal of emergencies,trauma, and shock 2015;8(2):88-93.
  • 9-Hess EP, Wyatt KD, Kharbanda AB. et al., Effectiveness of the head CT choice decision aid in parents of children with minor head trauma: study protocol for a multicenter randomized trial. Trials 2014;5(1):253.
  • 10-Kuppermann N., Pediatric head trauma: the evidence regarding indications for emergent neuroimaging. Pediatr Radiol 2008;38(4):670-4.
  • 11-Köksal Ö, Özeren G, Yenice H. ve ark. Minör Kafa Travmali Infantlarda Kranial Bilgisayarli Tomografi Gerekli mi?/Is Cranial Computerized Tomography Really Necessary for Infants With Minor Head Trauma? Journal of Academic Emergency Medicine 2011;10(2):56-9.
  • 12-Atmis A, Tolunay O, Çelik T. ve ark. Dilemma in pediatric head trauma: Is cranial Ccomputed tomography necessary or not in minor head traumas? Cocuk Acil ve Yoğun Bakım 2016;3(1):27-31.
  • 13-Erlichman DB, Blumfield E, Rajpathak S et al., Association between linear skull fractures and intracranial hemorrhage in children with minor head trauma. Pediatr Radiol 2010;40(8):1375-9.
  • 14-Homer CJ, Kleinman L. Technical report: minor head injury in children. Pediatrics 1999;104(6):78.
  • 15-Miglioretti DL, Johnson E, Williams A. et al, The use of computed tomography in pediatrics and the associated radiation exposure and estimated cancer risk. JAMA Pediatr 2013;167(8):700-707.
  • 16-Wong AC, Kowalenko T, Roahen-Harrison S. et al., A survey of emergency physicians fear of malpractice and its association with the decision to order computed tomography scans for children with minor head trauma. Pediatr Emerg Care 2011;27(3):182-5.
  • 17-Easter JS, Bakes K, Dhaliwal J et al., Comparison of PECARN, CATCH, and CHALICE rules for children with minor head injury: a prospective cohort study. Ann Emerg Med 2014;64(2):145-52.
  • 18-Babl FE, Lyttle MD, Bressan S. et al., A prospective observational study to assess the diagnostic accuracy of clinical decision rules for children presenting to emergency departments after head injuries (protocol): the Australasian Paediatric Head Injury Rules Study (APHIRST). BMC Pediatr 2014;14(1):148.
  • 19-Kuppermann N, Holmes JF, Dayan PS et al., Identification of children at very low risk of clinically-important brain injuries after head trauma: a prospective cohort study. Lancet 2009;374(9696):1160-70.
  • 20-Jennings RM., Burtner JJ, Pellicer JF et al. Reducing head CT use for children with head injuries in a community emergency department. Pediatrics 2017;139(4):e 20161349.
  • 21-Türedi S, Hasanbasoglu A, Gunduz A. et al., Clinical decision instruments for CT scan in minor head trauma. Journal of Emergency Medicine 2008;34(3):253-59.

2 Yaş Altı Çocuklarda Kafa Travmasının Değerlendirilmesinde Bilgisayarlı Tomografinin Rolü

Yıl 2018, Cilt: 10 Sayı: 3, 294 - 297, 23.10.2018
https://doi.org/10.18521/ktd.434957

Öz

Amaç: Kafa travması çocukların acil servise sık başvuru nedenlerindendir. Travma nedeniyle iki yaş altı çocukların bilgisayarlı tomografi gerekliliği açısından değerlendirilmesi oldukça zordur. Bu çalışmanın amacı 2 yaş altı çocukların değerlendirilmesinde gereksiz kranial bilgisayarlı tomografi çekimine dikkat çekmektir.

Gereç ve Yöntem: Acil Servise, yaşları 0-24 ay arası olan ve Ocak 2011 ile Aralık 2015 tarihleri arasında gelen kafa travmalı 183 olgunun kayıtları geriye dönük olarak incelenmiştir.

Bulgular: Çalışmaya dahil edilen 183 olgunun, 93’ü erkek (%50,8), 90’ı kız (%49,2) ve hastaların yaşları ortalama 13.08±6.30 (en küçük 1, en büyük 24) ay idi. Kazaların 139’u (%76) düşme, 24’ü (%13,1) araç dışı trafik kazası, 20’si (%10,9) araç içi trafik kazası sonucu gerçekleşmişti. Olguların %12’sine kranial bilgisayarlı tomografi çekilmezken, %80’ine çekilmişti. Kranial bilgisayarlı tomografi çekilen hastaların 7’sinde (%3,8) frontal kemikte, 1’inde (%0,5) temporal kemikte, 5’inde (%2,7) oksipital kemikte, 5’inde (%2,7) parietal kemikte kırık saptandı. Hastaların yatış süresi 0.54±2,90 ( en küçük 0, en büyük 27) gün idi. Olguların hiçbirinde operasyon gereksinimi olmadı.

Sonuç: İki yaş altı çocuklarda, kafa travmalarında bilgisayarlı tomografi çekilme oranındaki yükseklik dikkat çekici bulundu. Bu çalışma ile özellikle hafif kafa travmalı olgularda bilgisayarlı tomografi istenmesi için doğru endikasyon konulması, daha ayrıntılı ve objektif kriterleri belirleyen çalışmalar ile istemin azaltılması gerekliliği vurgulanmıştır.

Kaynakça

  • 1-Brenner DJ, Hall EJ. Computed tomography--an increasing source of radiation exposure. N Engl J Med 2007;357(22):2277-84.
  • 2-Schonfeld D, Fitz BM, Nigrovic LE. Effect of the duration of emergency department observation on computed tomography use in children with minor blunt head trauma. Annals of emergency medicine 2013;62(6):597-03.
  • 3-Wing R, James C. Pediatric head injury and concussion. Emerg Med Clin North Am 2013;31(3):653-75.
  • 4-Büyükcam F, Kaya U, Karakılıç ME. ve ark. Predicting the outcome in children with head trauma: comparison of FOUR score and Glasgow Coma Scale. Ulus Travma Acil Cerrahi Derg 2012;18(6):469-73.
  • 5-Demir ÖF, Aydın K, Turan F ve ark. Analysis of pediatric forensic cases presented to emergency department. Turk Arch Ped 2014;49(4):235-40.
  • 6-Işik HS, Gökyar A, Yildiz Ö. ve ark. Çocukluk çağı kafa travmaları, 851 olgunun retrospektif değerlendirilmesi: Epidemiyolojik bir çalışma. Ulus Travma Acil Cerrahi Derg 2011;17(2):166-72.
  • 7-Medwid K, Couri GG. How accurate are clinical decision rules for pediatric minor head injury? Ann Emerg Med 2012;60(3):278-9.
  • 8- Alharthy N, Al Queflie S, Alyousef K, et al., Clinical manifestations that predict abnormal brain computed tomography (CT) in children with minor head injury. Journal of emergencies,trauma, and shock 2015;8(2):88-93.
  • 9-Hess EP, Wyatt KD, Kharbanda AB. et al., Effectiveness of the head CT choice decision aid in parents of children with minor head trauma: study protocol for a multicenter randomized trial. Trials 2014;5(1):253.
  • 10-Kuppermann N., Pediatric head trauma: the evidence regarding indications for emergent neuroimaging. Pediatr Radiol 2008;38(4):670-4.
  • 11-Köksal Ö, Özeren G, Yenice H. ve ark. Minör Kafa Travmali Infantlarda Kranial Bilgisayarli Tomografi Gerekli mi?/Is Cranial Computerized Tomography Really Necessary for Infants With Minor Head Trauma? Journal of Academic Emergency Medicine 2011;10(2):56-9.
  • 12-Atmis A, Tolunay O, Çelik T. ve ark. Dilemma in pediatric head trauma: Is cranial Ccomputed tomography necessary or not in minor head traumas? Cocuk Acil ve Yoğun Bakım 2016;3(1):27-31.
  • 13-Erlichman DB, Blumfield E, Rajpathak S et al., Association between linear skull fractures and intracranial hemorrhage in children with minor head trauma. Pediatr Radiol 2010;40(8):1375-9.
  • 14-Homer CJ, Kleinman L. Technical report: minor head injury in children. Pediatrics 1999;104(6):78.
  • 15-Miglioretti DL, Johnson E, Williams A. et al, The use of computed tomography in pediatrics and the associated radiation exposure and estimated cancer risk. JAMA Pediatr 2013;167(8):700-707.
  • 16-Wong AC, Kowalenko T, Roahen-Harrison S. et al., A survey of emergency physicians fear of malpractice and its association with the decision to order computed tomography scans for children with minor head trauma. Pediatr Emerg Care 2011;27(3):182-5.
  • 17-Easter JS, Bakes K, Dhaliwal J et al., Comparison of PECARN, CATCH, and CHALICE rules for children with minor head injury: a prospective cohort study. Ann Emerg Med 2014;64(2):145-52.
  • 18-Babl FE, Lyttle MD, Bressan S. et al., A prospective observational study to assess the diagnostic accuracy of clinical decision rules for children presenting to emergency departments after head injuries (protocol): the Australasian Paediatric Head Injury Rules Study (APHIRST). BMC Pediatr 2014;14(1):148.
  • 19-Kuppermann N, Holmes JF, Dayan PS et al., Identification of children at very low risk of clinically-important brain injuries after head trauma: a prospective cohort study. Lancet 2009;374(9696):1160-70.
  • 20-Jennings RM., Burtner JJ, Pellicer JF et al. Reducing head CT use for children with head injuries in a community emergency department. Pediatrics 2017;139(4):e 20161349.
  • 21-Türedi S, Hasanbasoglu A, Gunduz A. et al., Clinical decision instruments for CT scan in minor head trauma. Journal of Emergency Medicine 2008;34(3):253-59.
Toplam 21 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Konular Sağlık Kurumları Yönetimi
Bölüm Makaleler
Yazarlar

Feruza Turan Sönmez Bu kişi benim 0000-0001-8817-8521

Önder Kılıçaslan Bu kişi benim 0000-0002-9311-006X

Gülşen Yalçın 0000-0002-5938-2619

Yayımlanma Tarihi 23 Ekim 2018
Kabul Tarihi 7 Ağustos 2018
Yayımlandığı Sayı Yıl 2018 Cilt: 10 Sayı: 3

Kaynak Göster

APA Turan Sönmez, F., Kılıçaslan, Ö., & Yalçın, G. (2018). 2 Yaş Altı Çocuklarda Kafa Travmasının Değerlendirilmesinde Bilgisayarlı Tomografinin Rolü. Konuralp Medical Journal, 10(3), 294-297. https://doi.org/10.18521/ktd.434957
AMA Turan Sönmez F, Kılıçaslan Ö, Yalçın G. 2 Yaş Altı Çocuklarda Kafa Travmasının Değerlendirilmesinde Bilgisayarlı Tomografinin Rolü. Konuralp Medical Journal. Ekim 2018;10(3):294-297. doi:10.18521/ktd.434957
Chicago Turan Sönmez, Feruza, Önder Kılıçaslan, ve Gülşen Yalçın. “2 Yaş Altı Çocuklarda Kafa Travmasının Değerlendirilmesinde Bilgisayarlı Tomografinin Rolü”. Konuralp Medical Journal 10, sy. 3 (Ekim 2018): 294-97. https://doi.org/10.18521/ktd.434957.
EndNote Turan Sönmez F, Kılıçaslan Ö, Yalçın G (01 Ekim 2018) 2 Yaş Altı Çocuklarda Kafa Travmasının Değerlendirilmesinde Bilgisayarlı Tomografinin Rolü. Konuralp Medical Journal 10 3 294–297.
IEEE F. Turan Sönmez, Ö. Kılıçaslan, ve G. Yalçın, “2 Yaş Altı Çocuklarda Kafa Travmasının Değerlendirilmesinde Bilgisayarlı Tomografinin Rolü”, Konuralp Medical Journal, c. 10, sy. 3, ss. 294–297, 2018, doi: 10.18521/ktd.434957.
ISNAD Turan Sönmez, Feruza vd. “2 Yaş Altı Çocuklarda Kafa Travmasının Değerlendirilmesinde Bilgisayarlı Tomografinin Rolü”. Konuralp Medical Journal 10/3 (Ekim 2018), 294-297. https://doi.org/10.18521/ktd.434957.
JAMA Turan Sönmez F, Kılıçaslan Ö, Yalçın G. 2 Yaş Altı Çocuklarda Kafa Travmasının Değerlendirilmesinde Bilgisayarlı Tomografinin Rolü. Konuralp Medical Journal. 2018;10:294–297.
MLA Turan Sönmez, Feruza vd. “2 Yaş Altı Çocuklarda Kafa Travmasının Değerlendirilmesinde Bilgisayarlı Tomografinin Rolü”. Konuralp Medical Journal, c. 10, sy. 3, 2018, ss. 294-7, doi:10.18521/ktd.434957.
Vancouver Turan Sönmez F, Kılıçaslan Ö, Yalçın G. 2 Yaş Altı Çocuklarda Kafa Travmasının Değerlendirilmesinde Bilgisayarlı Tomografinin Rolü. Konuralp Medical Journal. 2018;10(3):294-7.