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SERUM GFAP DÜZEYİ, MİNOR KAFA TRAVMALI ÇOCUKLARDA BEYİN TOMOGRAFİSİNE ALTERNATİF OLABİLİR Mİ?

Year 2014, Volume: 4 Issue: 1, 6 - 12, 06.08.2014
https://doi.org/10.16919/btd.72665

Abstract

Amaç: Serum Glial fibriler asidik protein (GFAP) düzeyleri nöron hasarının önemli bir belirteci-

dir. Bu çalışmada minor kafa travmalı (MKT) çocuklarda, serum GFAP’ın tanısal etkinliği ve beyin

BT’sine alternatif bir tanı yöntemi olup olamayacağının araştırılması amaçlandı.

Gereç ve Yöntemler: Orta ve yüksek riskli minor kafa travması olarak değerlendirilen, travmanın ilk altı saati içinde hastanemiz acil servisine başvuran 0- 6 yaş grubu 63 hasta ve 30 çocuk kontrol grubu çalışmaya alındı. Hastalara beyin BT çekildi. Travmanın 1. ve 3-5. saatlerinde serum GFAP düzeyleri ölçüldü.

Bulgular: Hastaların %38.1’inde kusma, %28.6’sında kafa kemiklerinde kırık, %28.6’sında sefal he- matom, %3.2’sinde epidural hematom saptandı. Serum GFAP düzeyi travma grubunda ortalama

2,250 ng/ml, kontrol grubunda ise ortalama 1,775 ng/ml idi. İki grup serum GFAP düzeyleri ara- sında anlamlı farklılık saptanmadı. Serum GFAP düzeyi, travmanın 1. saatinde ortalama 2,141 ng/ ml, 3-5.saatlerinde ise ortalama 3,011 ng/ml olarak saptandı. Birinci saat ile 3-5. saatler arasında alınan serum GFAP düzeyleri arasında istatiksel olarak anlamlı bir fark saptanmadı.

Sonuç: MKT’li çocuklarda bazen gereksiz beyin BT çekilmektedir. Serum GFAP ölçümü, MKT olgu- larının yönetiminde umut verici gözükmektedir. Çalışmamızda serum GFAP değerleri ile travmatik beyin yaralanması arasında ilişki saptanamamıştır. Ancak daha fazla hasta sayılarıyla yapılan yeni çalışmalara ihtiyaç duyulmaktadır.

Anahtar Kelimeler: Bilgisayarlı tomografi; Çocuklar; GFAP; Kırık; Minor kafa travması

ABSTRACT

Objective: Serum Glial Fibrillary Acidic Protein (GFAP) level is an important marker of neuronal

damage. In this study, it was aimed to evaluate  the diagnostic efficacy of serum GFAP and if it can be used as an alternative diagnostic method to brain CT at the minor head trauma (MHT) in children.

Materials and Methods: Sixty three patients between the age of 0-6 years who were admitted to the emergency department within the first six hours of the trauma and the control group of 30 children were studied. Cranial CT was performed in patients. Serum GFAP levels were measured at the first and 3-5. hours of the trauma.

Results: 38.1% of the patients’ had vomiting. 28.6% patients’ had skull fractures, 28.6% were determined cephal haematoma., 3.2% had an epidural hematoma. Average level of serum GFAP is

2.250 ng / ml in the trauma group and 1,775 ng / ml in the control group ((p=0,167). The average of serum levels of GFAP wasn’t a significant difference between the patients who admitted in the first hour and within 3-5. hours (2,141 ng / ml, 3,011 ng / ml; respectively )

Conclusion: Unnecessary brain CT is sometimes drawn at the minor head trauma in children. Measurement of GFAP appears to be promising for management of the patients with MHT. In our study, there was no relationship between the serum GFAP values and traumatic brain injury. However, the new studies with more number of patients are needed.

Key words: Computed tomography; Children; Glial Fibrillary Acidic Protein; Fracture; Minor head trauma

References

  • Hauda WE. Pediatrictrauma. In:Tintinalli JE, Kelen GD, Stapczynski JS, editors. Emergency medicine: a comprehen- sive study guide. 6th ed. New York: TheMcGraw-Hill, 2004. p.1542-9.
  • Verma S, Lal N, Lodha R, Murmu L. Childhood trauma profile at a tertiarycarehospital in India. Indian Pediatr. 2009;46(2):168-71.
  • Yanagawa Y, Sakamoto T. Characteristics of pediatric- trauma in an urban city in Japan. Pediatr EmergCare. 2009;25(9):272-4.
  • Gürses D, Sarıoğlu-Büke A, Başkan M, Herek Ö, Kılıç İ. Travma nedeniyle çocuk acil servise başvuran hastaların epidemiyolojik değerlendirmesi. Ulusal Travma Dergisi. 2002;8(3):156-9.
  • Beaudin M, Saint-Vil D, Quimet A, Mercier C, Crevier
  • L. Clinical algorithm and resourceuse in the manage- ment of children with minor head trauma. J Pediatr Surg. 2007;42(5):849-52.
  • Savitsky EA, Votey SR. Current controversies in the man- agement of minor pediatric head injuries. Am J EmergMed. 2000;18(1):96-101.
  • Işık HS, Gökyar A, Yıldız Ö, Bostancı U, Özdemir C. Çocukluk çağı kafa travmaları, 851 olgunun retrospektif değerlendirilmesi: Epidemiyolojik bir çalışma. Ulus Travma Acil Cerrahi Derg. 2011;17(2);166-72.
  • Karasu A, Sabancı PA, Cansever T, et al. Kafa travmalı hastalarda epidemiyolojik çalışma. Ulus Travma Acil Cerrahi Derg. 2009;15(2):159-63.
  • Matschke J, Herrmann B, Sperhake J, Körber F, Bajanowski T, Glatzel M. Shaken baby syndrome: a common variant
  • of non-accidental head injury in infants. Dtsch Arztebl Int. 2009; 106(13): 211-7.
  • Bowman SM, Bird TM, Aitken ME, Tilford JM. Trends in hospitalizations associated with pediatric traumatic brain injuries. Pediatrics. 2008;122(5):988-93.
  • Şimşek O, Hiçdönmez T, Hamamcıoğlu MK, et al. Pedi- atric head injuries: a retrospective analysis of 280 patients. Ulusal Travma Derg. 2005;11(4):310-7.
  • Da Dalt L, Marchi AG, Laudizi L, Crichiutti G, Messi G, Pa- vanello L,et al. Predictors of intracranial injuries in children after blunt head trauma. Eur J Pediatr. 2006;165(3):142-8.
  • Reed MJ, Browning JG, Wilkinson AG, Beattie T. Can we abolish skull X-rays for head injury? Arch Dis Child. 2005;90(8):859-64.
  • Brenner DJ. Estimating cancer risks from pediatric CT: go- ing from the qualitative to the quantitative. Pediatric Radiol. 2002;32(4):228-31.
  • Brenner DJ, HallE J. Computed tomography-an increasing source of radiation exposure. Nengl J Med. 2007; 357(22): 2277-84.
  • Galea E, Dupouey P, Feinstein DL. Glial fibrillary acidic protein mRNA isotypes: expression invitro and in-vivo. Neu- rosciRes. 1995; 41(4): 452-61.
  • Crooks DA. The pathological concept of diffuse axonal injury in head trauma. J Pathol. 1991;165(1): 5–10.
  • Missler U, Wiesmann M, Wittmann G, Magerkurth O, Hagenström H. Measurement of glial fibrillary acidic protein in human blood: analytical method and preliminary clinical results. Clin Chem.1999;45(1):138-41.
  • -
  • Wiesmann M, Steinmeier E, Magerkurth O, Linn J, Gottmann D, Missler U. Outcome prediction in traumatic brain injury: comparison of neurological status, CT findings and blood levels of S100B and GFAP. Acta Neurol Scand. 2010;121(3):178-85.
  • Missler M, Eins S, Böttcher H, Wolff JR. Postnatal development of glial fibrillary acidic protein, vimentin and S100 protein in monkey visual cortex: evidencefor a tran- sient reduction of GFAP immunoreactivity. Dev Brain Res. 1994;82(1-2):103-17.
  • Schmitt B, Bauersfeld U, Schmid ER, et al. Serum and CSF levels of neuron-specific enolase (NSE) in cardiac surgery with cardiopulmonary bypass: a marker of brain injury? Brain Dev. 1998; 20(7): 536-9.
  • Lumpkins KM, Bochicchio GV, Keledjian K, Simard JM, McCunn M, Thomas Scalea T. Glial Fibrillary Acidic Protein is Highly Correlated With Brain Injury. J Trauma. 2008; 65(4): 778-84.
  • Pelinka LE, Kroepfl A, Leixnering M, Buchinger W, Raabe A, Redl H. GFAP Versus S100B in Serum after Traumatic Brain Injury: Relation ship to Brain Damage and Outcome. J Neu- rotrauma. 2004;21(11):1553-61.
  • Zŭrek J,Fedora M. Dynamics of Glial Fibrillary Acidic Protein During Traumatic Brain Injury in Children. J Trauma. 2011;71(4):854-9.
  • Akdur O, İkizceli İ, Sözüer EM, Avşaroğulları L, Kılıç Ş, Taymuş E. Okul öncesi çocukluk dönemi kafa travmalarının incelenmesi [Evaluation of pediatric head traumas preschool age period]. Turk J EmergMed. 2006;6(4):158-62.
  • Köksal Ö, Özeren G, Yenice H, Çildir E. Minor kafa travmalı infantlarda kranial bilgisayarlı tomografi gerekli mi? JAEM. 2011;10(2):56-9.
  • Olshaker JS, Whye DW Jr. Head Trauma. Emergency Medicine Clinics of North America. 1993;11(1):165-86.
  • Schutzman SA, Greenes DS. Pediatric minor headt rauma. Ann Emerg Med 2001;37(1):65-74.
  • Woodcock RJ, Davis PC, Hopkins KL. Imaging of head trauma in infancy and childhood. Semin Ultrasound CT MR. 2001;22(2):162-82.
  • Goodwin V, Evans RJ. The management of children with head injuries. Current Pediatrics. 2001;11(6):420-32.
  • Stein SC, Ross SE. Mild head injury: a plea for routine early CT scanning. J Trauma. 1992;33(1):11-3.
  • Miller EC, Derlet RW, Kinser D. Minor head trauma: Is computed tomography always necessary? Ann Emerg Med. 1996;27(3):290-94.
  • Wang MY, Griffith P, Sterling I, et al. A prospective popu- lation- based study of pediatric trauma patients with mild alterations in consciousness (Glasgow ComaScalescore of
  • - 14). Neurosurgery. 2000;46(5):1093-9.
  • Greenes DS, Schultman SA. Clinical indicators of intracranial injury in head injuried infants. Pediatrics. 1999;104(4):861-7.
  • Quayle KS. Minor head injury in the pediatric patient. Pediatr Clin North Am. 1999;46(6):1189-99.
  • Gruskin KD, Schutzman SA. Head trauma in children younger than 2 years: are there predictors for complica- tions? Arch Pediatr Adolesc Med. 1999;153(1):15-20.
  • Türedi S, Hasanbaşoğlu A, Gündüz A, Yandı M. Clinical desicion instruments for CT scan in minor head trauma. J Emerg Med. 2008;34(3):253-9.
  • Kochanek PM, Berger RP, Bayir H, Wagner AK, Jenkins LW, Clark RS. Biomarkers of primary and evolving damage
  • in traumatic and ischemic brain injury: diagnosis, prognosis, probing mechanisms, and therapeutic decision making. Curr Opin Crit Care. 2008;14(2):135-41.
  • Mirzai H, Yağlı N, Tekin İ. Celal Bayar Üniversitesi Tıp Fakültesi acil birimine başvuran kafa travmalı olguların epidemiyolojik ve klinik özellikleri [Epidemiologic and clinical features of cases applying to Celal Bayar Univer- sity emergecy unit with headtrauma]. Ulus Travma Derg. 2005;11(2):146-52.
Year 2014, Volume: 4 Issue: 1, 6 - 12, 06.08.2014
https://doi.org/10.16919/btd.72665

Abstract

References

  • Hauda WE. Pediatrictrauma. In:Tintinalli JE, Kelen GD, Stapczynski JS, editors. Emergency medicine: a comprehen- sive study guide. 6th ed. New York: TheMcGraw-Hill, 2004. p.1542-9.
  • Verma S, Lal N, Lodha R, Murmu L. Childhood trauma profile at a tertiarycarehospital in India. Indian Pediatr. 2009;46(2):168-71.
  • Yanagawa Y, Sakamoto T. Characteristics of pediatric- trauma in an urban city in Japan. Pediatr EmergCare. 2009;25(9):272-4.
  • Gürses D, Sarıoğlu-Büke A, Başkan M, Herek Ö, Kılıç İ. Travma nedeniyle çocuk acil servise başvuran hastaların epidemiyolojik değerlendirmesi. Ulusal Travma Dergisi. 2002;8(3):156-9.
  • Beaudin M, Saint-Vil D, Quimet A, Mercier C, Crevier
  • L. Clinical algorithm and resourceuse in the manage- ment of children with minor head trauma. J Pediatr Surg. 2007;42(5):849-52.
  • Savitsky EA, Votey SR. Current controversies in the man- agement of minor pediatric head injuries. Am J EmergMed. 2000;18(1):96-101.
  • Işık HS, Gökyar A, Yıldız Ö, Bostancı U, Özdemir C. Çocukluk çağı kafa travmaları, 851 olgunun retrospektif değerlendirilmesi: Epidemiyolojik bir çalışma. Ulus Travma Acil Cerrahi Derg. 2011;17(2);166-72.
  • Karasu A, Sabancı PA, Cansever T, et al. Kafa travmalı hastalarda epidemiyolojik çalışma. Ulus Travma Acil Cerrahi Derg. 2009;15(2):159-63.
  • Matschke J, Herrmann B, Sperhake J, Körber F, Bajanowski T, Glatzel M. Shaken baby syndrome: a common variant
  • of non-accidental head injury in infants. Dtsch Arztebl Int. 2009; 106(13): 211-7.
  • Bowman SM, Bird TM, Aitken ME, Tilford JM. Trends in hospitalizations associated with pediatric traumatic brain injuries. Pediatrics. 2008;122(5):988-93.
  • Şimşek O, Hiçdönmez T, Hamamcıoğlu MK, et al. Pedi- atric head injuries: a retrospective analysis of 280 patients. Ulusal Travma Derg. 2005;11(4):310-7.
  • Da Dalt L, Marchi AG, Laudizi L, Crichiutti G, Messi G, Pa- vanello L,et al. Predictors of intracranial injuries in children after blunt head trauma. Eur J Pediatr. 2006;165(3):142-8.
  • Reed MJ, Browning JG, Wilkinson AG, Beattie T. Can we abolish skull X-rays for head injury? Arch Dis Child. 2005;90(8):859-64.
  • Brenner DJ. Estimating cancer risks from pediatric CT: go- ing from the qualitative to the quantitative. Pediatric Radiol. 2002;32(4):228-31.
  • Brenner DJ, HallE J. Computed tomography-an increasing source of radiation exposure. Nengl J Med. 2007; 357(22): 2277-84.
  • Galea E, Dupouey P, Feinstein DL. Glial fibrillary acidic protein mRNA isotypes: expression invitro and in-vivo. Neu- rosciRes. 1995; 41(4): 452-61.
  • Crooks DA. The pathological concept of diffuse axonal injury in head trauma. J Pathol. 1991;165(1): 5–10.
  • Missler U, Wiesmann M, Wittmann G, Magerkurth O, Hagenström H. Measurement of glial fibrillary acidic protein in human blood: analytical method and preliminary clinical results. Clin Chem.1999;45(1):138-41.
  • -
  • Wiesmann M, Steinmeier E, Magerkurth O, Linn J, Gottmann D, Missler U. Outcome prediction in traumatic brain injury: comparison of neurological status, CT findings and blood levels of S100B and GFAP. Acta Neurol Scand. 2010;121(3):178-85.
  • Missler M, Eins S, Böttcher H, Wolff JR. Postnatal development of glial fibrillary acidic protein, vimentin and S100 protein in monkey visual cortex: evidencefor a tran- sient reduction of GFAP immunoreactivity. Dev Brain Res. 1994;82(1-2):103-17.
  • Schmitt B, Bauersfeld U, Schmid ER, et al. Serum and CSF levels of neuron-specific enolase (NSE) in cardiac surgery with cardiopulmonary bypass: a marker of brain injury? Brain Dev. 1998; 20(7): 536-9.
  • Lumpkins KM, Bochicchio GV, Keledjian K, Simard JM, McCunn M, Thomas Scalea T. Glial Fibrillary Acidic Protein is Highly Correlated With Brain Injury. J Trauma. 2008; 65(4): 778-84.
  • Pelinka LE, Kroepfl A, Leixnering M, Buchinger W, Raabe A, Redl H. GFAP Versus S100B in Serum after Traumatic Brain Injury: Relation ship to Brain Damage and Outcome. J Neu- rotrauma. 2004;21(11):1553-61.
  • Zŭrek J,Fedora M. Dynamics of Glial Fibrillary Acidic Protein During Traumatic Brain Injury in Children. J Trauma. 2011;71(4):854-9.
  • Akdur O, İkizceli İ, Sözüer EM, Avşaroğulları L, Kılıç Ş, Taymuş E. Okul öncesi çocukluk dönemi kafa travmalarının incelenmesi [Evaluation of pediatric head traumas preschool age period]. Turk J EmergMed. 2006;6(4):158-62.
  • Köksal Ö, Özeren G, Yenice H, Çildir E. Minor kafa travmalı infantlarda kranial bilgisayarlı tomografi gerekli mi? JAEM. 2011;10(2):56-9.
  • Olshaker JS, Whye DW Jr. Head Trauma. Emergency Medicine Clinics of North America. 1993;11(1):165-86.
  • Schutzman SA, Greenes DS. Pediatric minor headt rauma. Ann Emerg Med 2001;37(1):65-74.
  • Woodcock RJ, Davis PC, Hopkins KL. Imaging of head trauma in infancy and childhood. Semin Ultrasound CT MR. 2001;22(2):162-82.
  • Goodwin V, Evans RJ. The management of children with head injuries. Current Pediatrics. 2001;11(6):420-32.
  • Stein SC, Ross SE. Mild head injury: a plea for routine early CT scanning. J Trauma. 1992;33(1):11-3.
  • Miller EC, Derlet RW, Kinser D. Minor head trauma: Is computed tomography always necessary? Ann Emerg Med. 1996;27(3):290-94.
  • Wang MY, Griffith P, Sterling I, et al. A prospective popu- lation- based study of pediatric trauma patients with mild alterations in consciousness (Glasgow ComaScalescore of
  • - 14). Neurosurgery. 2000;46(5):1093-9.
  • Greenes DS, Schultman SA. Clinical indicators of intracranial injury in head injuried infants. Pediatrics. 1999;104(4):861-7.
  • Quayle KS. Minor head injury in the pediatric patient. Pediatr Clin North Am. 1999;46(6):1189-99.
  • Gruskin KD, Schutzman SA. Head trauma in children younger than 2 years: are there predictors for complica- tions? Arch Pediatr Adolesc Med. 1999;153(1):15-20.
  • Türedi S, Hasanbaşoğlu A, Gündüz A, Yandı M. Clinical desicion instruments for CT scan in minor head trauma. J Emerg Med. 2008;34(3):253-9.
  • Kochanek PM, Berger RP, Bayir H, Wagner AK, Jenkins LW, Clark RS. Biomarkers of primary and evolving damage
  • in traumatic and ischemic brain injury: diagnosis, prognosis, probing mechanisms, and therapeutic decision making. Curr Opin Crit Care. 2008;14(2):135-41.
  • Mirzai H, Yağlı N, Tekin İ. Celal Bayar Üniversitesi Tıp Fakültesi acil birimine başvuran kafa travmalı olguların epidemiyolojik ve klinik özellikleri [Epidemiologic and clinical features of cases applying to Celal Bayar Univer- sity emergecy unit with headtrauma]. Ulus Travma Derg. 2005;11(2):146-52.
There are 44 citations in total.

Details

Primary Language Turkish
Journal Section Original Research
Authors

Halil Çıkrıklar This is me

Mehmet Ekici

Didem Coşan This is me

Arzu Ekici This is me

Yasemin Üstündağ This is me

Mümin Karaali This is me

Mahmut Kaynak This is me

Kamil Uz This is me

Canan Baydemir This is me

Yusuf Yürümez This is me

Publication Date August 6, 2014
Published in Issue Year 2014 Volume: 4 Issue: 1

Cite

APA Çıkrıklar, H., Ekici, M., Coşan, D., Ekici, A., et al. (2014). SERUM GFAP DÜZEYİ, MİNOR KAFA TRAVMALI ÇOCUKLARDA BEYİN TOMOGRAFİSİNE ALTERNATİF OLABİLİR Mİ?. Bozok Tıp Dergisi, 4(1), 6-12. https://doi.org/10.16919/btd.72665
AMA Çıkrıklar H, Ekici M, Coşan D, Ekici A, Üstündağ Y, Karaali M, Kaynak M, Uz K, Baydemir C, Yürümez Y. SERUM GFAP DÜZEYİ, MİNOR KAFA TRAVMALI ÇOCUKLARDA BEYİN TOMOGRAFİSİNE ALTERNATİF OLABİLİR Mİ?. Bozok Tıp Dergisi. July 2014;4(1):6-12. doi:10.16919/btd.72665
Chicago Çıkrıklar, Halil, Mehmet Ekici, Didem Coşan, Arzu Ekici, Yasemin Üstündağ, Mümin Karaali, Mahmut Kaynak, Kamil Uz, Canan Baydemir, and Yusuf Yürümez. “SERUM GFAP DÜZEYİ, MİNOR KAFA TRAVMALI ÇOCUKLARDA BEYİN TOMOGRAFİSİNE ALTERNATİF OLABİLİR Mİ?”. Bozok Tıp Dergisi 4, no. 1 (July 2014): 6-12. https://doi.org/10.16919/btd.72665.
EndNote Çıkrıklar H, Ekici M, Coşan D, Ekici A, Üstündağ Y, Karaali M, Kaynak M, Uz K, Baydemir C, Yürümez Y (July 1, 2014) SERUM GFAP DÜZEYİ, MİNOR KAFA TRAVMALI ÇOCUKLARDA BEYİN TOMOGRAFİSİNE ALTERNATİF OLABİLİR Mİ?. Bozok Tıp Dergisi 4 1 6–12.
IEEE H. Çıkrıklar, “SERUM GFAP DÜZEYİ, MİNOR KAFA TRAVMALI ÇOCUKLARDA BEYİN TOMOGRAFİSİNE ALTERNATİF OLABİLİR Mİ?”, Bozok Tıp Dergisi, vol. 4, no. 1, pp. 6–12, 2014, doi: 10.16919/btd.72665.
ISNAD Çıkrıklar, Halil et al. “SERUM GFAP DÜZEYİ, MİNOR KAFA TRAVMALI ÇOCUKLARDA BEYİN TOMOGRAFİSİNE ALTERNATİF OLABİLİR Mİ?”. Bozok Tıp Dergisi 4/1 (July 2014), 6-12. https://doi.org/10.16919/btd.72665.
JAMA Çıkrıklar H, Ekici M, Coşan D, Ekici A, Üstündağ Y, Karaali M, Kaynak M, Uz K, Baydemir C, Yürümez Y. SERUM GFAP DÜZEYİ, MİNOR KAFA TRAVMALI ÇOCUKLARDA BEYİN TOMOGRAFİSİNE ALTERNATİF OLABİLİR Mİ?. Bozok Tıp Dergisi. 2014;4:6–12.
MLA Çıkrıklar, Halil et al. “SERUM GFAP DÜZEYİ, MİNOR KAFA TRAVMALI ÇOCUKLARDA BEYİN TOMOGRAFİSİNE ALTERNATİF OLABİLİR Mİ?”. Bozok Tıp Dergisi, vol. 4, no. 1, 2014, pp. 6-12, doi:10.16919/btd.72665.
Vancouver Çıkrıklar H, Ekici M, Coşan D, Ekici A, Üstündağ Y, Karaali M, Kaynak M, Uz K, Baydemir C, Yürümez Y. SERUM GFAP DÜZEYİ, MİNOR KAFA TRAVMALI ÇOCUKLARDA BEYİN TOMOGRAFİSİNE ALTERNATİF OLABİLİR Mİ?. Bozok Tıp Dergisi. 2014;4(1):6-12.
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