Comparison of Control Neurological Evaluation and Control Tomography in the Management of Patients with Blunt Minor Head Trauma

Year 2023, , 165 - 169, 29.12.2023

Erkman Sanrı , Sinan Karacabey , Emir Ünal , Arzu Denizbaşı

https://doi.org/10.54996/anatolianjem.1377434

Abstract

Aim: Head computed tomography(CT) has a high diagnostic value for intracranial hemorrhage(ICH) patients. Routine control head CT(CHCT) is widely used in the emergency department(ED) for the follow-up of minor head trauma patients (MHT) with ICH. However, due to additional radiation exposure, the unnecessary application of CHCT should be avoided. Past studies showed that; CHCT has limited value in predicting the need for emergency neurosurgical intervention or intensive care unit(ICU) treatment in patients without neurological deterioration. In our study, we compared the value of control clinical evaluations(CCE) and CHCT in predicting emergency surgical intervention and ICU admission.

Material and Methods: In this prospective observational study, patients who were admitted to the ED with blunt MHT, who were diagnosed with ICH, GCS of 13-15, had no neurological disorder, and > 18 years of age were included. In the ED, neurological deterioration in CCE and lesion progression in CHCT should be sought during the followup of patients with ICH. Every 1-4 hours, CCE was applied to patients. If the CCEs were normal, CHCT was performed at the 4th and 24th hours; if neurological regression was present in CCE, CHCT was performed instantly. Sensitivity, specificity, positive predictive value(PPV), and negative predictive value(NPV) of CCE and CHCT for the need for neurosurgical intervention or ICU treatment were calculated.

Results: 183 patients were included in this study. The median age of patients was 43.1 years and 31.7% were female. The most common, trauma mechanism was reported as assault (29.5%), and intracranial lesion was reported as intracerebral hemorrhage or contusion (38.3%). The need for surgical intervention was 4.9% and ICU treatment was 2.7%. Neurological deterioration in CCE and progression in CHCT were detected in all patients who required surgical intervention or ICU. We found no need for surgical intervention or ICU in patients with stable CCE. Patients with progressed CHBT but stable CCE also had no need for surgery or ICU. The NPV and PPV of normal CCE and stable CHBT were calculated as 100% and 100%, 32.6% and 36.8%, respectively.

Conclusion: We report similar values of CCE and CHCT in predicting surgical intervention or ICU. The majority of patients without neurological deterioration were discharged to home, and HBCT did not contribute to diagnosis. Radiation exposure can be reduced by limiting the CHCT to neurologically deteriorated MHT patients.

Keywords

Emergency department, intracranial hemorrhage, minor head trauma, repeat CT

Künt Minör Kafa Travmalı Hastaların Yönetiminde Kontrol Nörolojik Değerlendirme ve Kontrol Tomografinin Değerliliklerini Karşılaştırılması

Abstract

Amaç: Kraniyal bilgisayarlı tomografi (BT), intrakraniyal kanamada (İKK) yüksek tanısal değerliliğe sahiptir. İntrakraniyal kanama tespit edilmiş minör kafa travmalı hastaların acil servis takiplerinde kontrol kraniyal BT (KKBT) uygulaması yaygın olarak kullanmaktadır. KKBT uygulaması hastalara radyasyon yükü oluşturmaktadır ve gereksiz kullanımından kaçınılmalıdır. Geçmiş çalışmalar; nörolojik gerilemesi olmayan hastaların acil cerrahi girişim veya YB ihtiyacını öngördürmede KKBT’nin değerliliğinin sınırlı olduğunu kaydetmişlerdir. Çalışmamızda, kontrol klinik değerlendirmelerin (KKD) ve KKBTuygulamalarının, acil cerrahi girişim ve YB yatış durumunu öngördürmedeki değerliliklerini karşılaştırdık.

Gereç ve Yöntemler: Bu prospektif gözlemsel çalışmaya, acil servise künt minör kafa travması (MKT) nedeniyle başvuran ve İKK tespit edilen, GKS: 13-15 olan, nörolojik bozukluğu olmayan, 18 yaş üstü
hastalar dahil edilmiştir. Acil Serviste intrakraniyal kanamalı hasta takiplerinde, KKD’de nörolojik gerileme ve KKBT’de ise İKK lezyonu progresyonu aranmaktadır. Hastalara her 1-4 saatte bir KKD uygulanmıştır. Eğer KKD’ler normal ise KKBT 4. ve 24. saatte, eğer KKD’de nörolojik gerileme tespit edildiyse o anda KKBT uygulanmıştır. KKD ve KKBT sonuçları, cerrahi girişim veya YB yatış durumu için duyarlılık, özgüllük, pozitif prediktif değer (PPD), negatif prediktif değer (NPD) hesaplanmıştır.

Bulgular: Çalışmaya 183 hasta dahil edilmiştir. Bu hastaların ortanca yaşı 43,1 yıldır ve %31,7’si kadındır. En sık görülen travma mekanizması darp (%29,5), intrakraniyal lezyon ise intraserebral kanama veya kontüzyon (%38,3) olarak raporlanmıştır. Hastaların %4,9’unda cerrahi girişim ve %2,7’sinde YB yatışı ihtiyacı gelişmiştir. Cerrahi girişim veya YB ihtiyacı gelişen tüm hastalarda KKD’de nörolojik kötüleşme ve KKBT’de progresyon tespit edilmiştir. KKD’leri stabil olan hastalarda acil cerrahi girişim veya YB yatış ihtiyacı gelişmemiştir. KKD’leri stabil ancak KKBT’leri progrese hastaların hiçbirinde cerrahi veya YB ihtiyacı gelişmemiştir. Acil cerrahi girişim veya YB yatış ihtiyacı için normal KKD ve stabil KKBT’nin NPD ve PPD’leri sırasıyla %100,0 ve %100,0, %32,6 ve %36,8 olarak hesaplanmıştır.

Sonuç: Acil cerrahi girişim veya YB yatış durumunu öngördürmede, KKD ve KKBT, benzer değerlilikte raporlanmıştır. Klinik değerlendirmelerinde nörolojik gerileme olmayan hastaların büyük çoğunluğu acilden eve taburcu olmuştur ve KKBT ek tanısal katkı sağlamamıştır. Hastalar nörolojik olarak stabil oldukları sürece kontrol BT uygulanmaması hastaların radyasyon maruziyetlerini azaltacaktır.

Keywords

Acil servis, intrakraniyal kanama, minör kafa travması, tekrar BT

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