Acil Servise Minör Kafa Travması İle Başvuran Çocukların Retrospektif Değerlendirilmesi

Year 2020, Volume: 3 Issue: 1, 14 - 7, 30.03.2020

Şimşek Çelik Fatma Kukul Güven

Abstract

Amaç
Acil servise minör kafa travması ile başvuran çocuklardaki anamnez ve muayene bulgularına göre, hangilerinde daha ciddi tomografi görüntüleri olduğunu ve beyin tomografilerinin gerekliliğini tespit etmeyi amaçladık. Ayrıca bu bulgular ile operasyon gerekliliği arasındaki ilişkiyi belirlemeyi amaçladık.

Gereç ve Yöntemler
Çalışmamız 01.01.2013- 31.12.2015 tarihleri arasında Sivas Devlet (Numune) Hastanesi acil servise minör kafa travmasıyla başvuran 835 hasta ile retrospektif olarak yapılmıştır. Kafa travması nedeniyle acil servise ilk 24 saatte getirilen çocukların yaş, cinsiyet, vital bulgular, kafa travmasının, yeri ve şekli, nörolojik ve mental durumu, kusma olup olmadığı radyolojik bulguları ve cerrahi müdahale yapılıp yapılmadığı gibi durumlar değerlendirilmiştir.

Bulgular
Hastaların 41 (4.9%)’inde hematom büyüklüğünün 2 santimetreden (cm) daha büyük olduğu, 65 (7.8%)’inde hematom yerinin parietal bölge olduğu görülmüştür. Anamnezinde senkop, nöbet ve bilinç bulanıklığı olan hastalarda daha ciddi klinik durumlar tespit edilmiştir. Hastaların 12 (1.4%)’sine cerrahi müdahale yapılmıştır. Cerrahi müdahale yapılan hastaların hematom büyüklüğünün 2cm’den büyük, en çok parietal bölgede olduğu ve bu vakaların 1’den fazla kustuğu tespit edilmiştir.

Sonuç
Skalp hematomunun 2 santimetreden büyük olması, hematom yerinin parietal bölgede olması, anamnezinde bilinç bulanıklığı, nöbet, senkop ve 1’den çok kusma tarifleyen hastalarda daha ciddi klinik sonuçlar görülmüştür.

Keywords

Acil Servis, Çocuk hasta, Minör kafa travması

Retrospective Evaluation of Children Presenting to the Emergency Department with Minor Head Trauma

Abstract

Aim
According to the anamnesis and examination findings in children presenting to the emergency department with minor head trauma, we aimed to determine which ones had more severe tomography images and the necessity of brain tomography.

Material and Methods
Our study was performed retrospectively with 835 patients who applied to Sivas State (Numune) Hospital emergency department with minor head trauma between 01.01.2013 and 31.12.2015. Age, gender, vital signs, location and shape of head trauma, neurological and mental status, presence of vomiting, radiological findings and surgical intervention were evaluated in the first 24 hours.

Results
In 41 (4.9%) patients, hematoma size was greater than 2 centimeters (cm) and in 65 (7.8%) hematoma location was parietal region. Anamnesis has been identified more severe clinical conditions in patients with syncope, seizures and confusion. Surgical intervention was performed in 12 (1.4%) patients. It was determined that the hematoma size of the patients undergoing surgical intervention was greater than 2 cm, mostly in the parietal region and these cases vomited more than one.

Conclusion
More serious clinical results were seen in patients with scalp hematoma greater than 2 centimeters, location of the hematoma in the parietal region, blurred consciousness, seizure, syncope and vomiting more than one.

Keywords

Emergency, Child patient, Minor head injury

References

• 1. 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; 374:1160-70.
• 2. Crowe LM, Hearps S, Anderson V, et al. Investigating the variability in mild traumatic brain injury definitions: a prospective cohort study. Arch Phys Med Rehabil 2018; 99:1360-9.
• 3. Mathews JD, Forsythe AV, Brady Z, et al. Cancer risk in 680,000 people exposed to computed tomography scans in childhood or adolescence: data linkage study of 11 million Australians. BMJ 2013; 346: f2360.
• 4. Miglioretti DL, Johnson E, Williams A, et al. The use of computed tomography in pediatricsand the associated radiation exposure and estimated cancer risk. JAMA Pediatr 2013; 167:700-7.
• 5. Smith-Bindman R, Kwan ML, Marlow EC, et al. Trends in use of medical imaging in US health care systems and in Ontario, Canada, 2000-2016. JAMA 2019; 322:843-56.
• 6. Er A, Akman C, Alataş I et al. Minör Kafa Travması Olan Çocuklarda Rutin Olarak BT Yapmalı mıyız? Should Children with Minor Head Injury Routinely Have CT Scan? JOPP Derg 5(3):131-135, 2013 doi:10.5222/JOPP.2013.131
• 7. 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; 374:1160–1170.
• 8. Babl FE, Borland ML, Phillips N, et al. Accuracy of PECARN, CATCH, and CHALICE head injury decision rules in children: a prospective cohort study. Lancet. 2017; 389:2393–2402.
• 9. Fundarò C, Caldarelli M, Monaco S, Cota F, Giorgio V, et al. Brain CT scan for pediatric minor accidental head injury. An Italian experience and review of literature. Childs Nerv Syst 2012; 28: 1063-8. http://dx.doi.org/10.1007/s00381-012-1717-9 PMid:22349902
• 10. Schutzman SA, Greenes DS. Pediatric minor head trauma. Ann Emerg Med, 2001; 37:65-74. http://dx.doi.org/10.1067/mem.2001.109440 PMid:11145776
• 11. Bressan S, Romanato S, Mion T, Zanconato S, Da Dalt L Acad Emerg Med. 2012 Jul;19(7): 801-7.doi:10.1111/j.1553-2712.2012.01384.x. Epub 2012 Jun 22. Implementation of adapted PECARN decision rule for children with minor headinjury in the pediatric emergency department.
• 12. Atabaki SM. Pediatric Head Injury. Pediatrics in Review 2007;28(6):215-24. PMid:17545333
• 13. Osmond MH, KlassenTP, Wells GA. Pediatric Emergency Research Canada (PERC) Head Injury Study Group. CATCH: a clinical decision rule for the use of computed tomography in children with minor head injury. CMAJ 2010;182(4):341-8. http://dx.doi.org/10.1503/cmaj.091421
• 14. Servadei F, Teasdale G, Merry G .Defining Acute Mild Head Injury in Adults: A Proposal Based on Prognostic Factors, Diagnosis, and Management. Journal of Neurotrauma.Jul 2001.657-664. http://doi.org/10.1089/089771501750357609
• 15. Osmond MH, Klassen TP , Wells GA et al and for the Pediatric Emergency Research Canada (PERC) Head Injury Study Group.Validation and refinement of a clinical decision rule for the use of computed tomography in children with minor head injury in the emergency department. CMAJ July 09, 2018;190 (27):E816-E822. DOI: https://doi.org/10.1503/cmaj.170406
• 16. Rhine T, Wade SL, Zhang N et al. Factors influencing ED care of young children at-risk for clinically important traumatic brain injury.Am J Emerg Med. 2018 Jun;36(6):1027-1031. doi: 10.1016/j.ajem.2018.01.089.