Acil Serviste Minör Pediatrik Kafa Travmasında Hematolojik Belirteçlerin Değerlendirilmesi

Abstract

Öz. Amaç:Çocukluk yaş grubunda morbidite ve mortalitenin en sık sebebi kafatravmalarıdır. Kafa travması olan çocuklarda beyin tomografisi için çeşitli protokoller tanımlanmıştır. Bunlarda klinik değerlendirmeler ön plana çıktığı için acil servislerde uygunsuz, abartılı hasta şikayetleri veya aşırı iş yükü yoğunluğu nedeniyle beyin tomografisi çekimi için karar vermek zor olabilir. Çalışmamızda minör pediatrik kafa travmalı hastalarda, beyin tomografisi çekimine karar verme aşamasında nötrofil-lenfositoranı ve trombosit-lenfosit oranının yol gösterici olup olamayacağını araştırmayı amaçladık. Materyal ve Metod: Bu retrospektif çalışmaya beyin tomografisi taramalarında patolojisi olan 96 hasta(grup I), yaşı ve cinsiyet bakımından bu gruba denk olan normal sağlıklı ve beyin tomografisi sonucu olan 99 (grup II) çocuk dâhil edildi. Grup 1 medikal ve cerrahi tedavi almalarına göre iki gruba ayrıldı. Hematolojik parametreler rutin laboratuvar yöntemleri ile çalışıldı. Her katılımcıda rutin hematolojik parametreler incelendi. Bulgular: Gruplar karşılaştırıldığında, nötrofil, lökosit, nötrofil-lenfosit oranı ve trombosit-lenfosit oranı grup I’ de grup 2’ye göre anlamlı derecede yüksekti (tümü için p<0.05). Alt grup analizlerinde; grup I’ de cerrahi tedavi gereken hastalarda nötrofil-lenfosit oranı ve trombosit-lenfosit oranı medikal izlem gerektiren hastalara göre istatiksel olarak anlamlı derecede yüksekti (tümü için p<0.05). Receiver operating characteristic analizi nötrofil-lenfosit oranı ve trombosit-lenfosit oranının minor kafatravmasında patoloji ve cerrahiyi öngörmede önemli olabileceğini göstermektedir. Sonuç: Minör kafa travmalarında nötrofil-lenfosit oranı ve trombosit-lenfosit oranının yüksekliği beyin tomografisi çekimi gerekliliği için yol gösterici olabilir. Ek olarak, bu parametreler patoloji saptanması durumunda uygulanacak tedavi yöntemini seçmede de yardımcı olabilir.

Keywords

• Hemotolojik değerler;
• Acil servis;
• Minör kafa travması

Evaluation of the Clinical Significance of Hematological Markers in Pediatric Patients Presenting to the Emergency Department with Minor Head Trauma

Abstract

Background: The most common cause of morbidity and mortality in childhood is head injuries. Various protocols have been described for brain tomography (BT) in children with head trauma. Because clinical evaluations come to thefore in these, it may be difficult to decide for brain tomography necessity due to inappropriate, exaggerated patient complaint or excessive workload intensity in emergency departments. In our study, we aimed to investigate whether neutrophil-lymphocyte ratio (NLO) and platelet-lymphocyte ratio (PLO) can be a guide in decision-making of necessity in patients with minor pediatric head trauma.
Methods:The files of 195 patients who were admitted to our hospital emergency department with an isolated minor pediatric head injury between January 1, 2015 and October 31, 2018 were retrospectively analyzed. Patients were divided into two groups according to CT result: Patients with minor pathology in CT (n = 96 patients, Group 1) and patients with normal CT results (n = 99, Group 2). Patients in group 1 were also divided into two groups according to their medical and surgical treatment. Routine hematological parameters were compared between the groups.
Results:When compared to group 2, neutrophil count, leukocyte count, NLO and PLO were significantly higher in group 1 (p <0.05, for all). In subgroup analysis; patients who required surgical treatment were significantly higher NLO and PLO levels than patients who required medical follow-up in group 1 (p <0.05 for all). In the Receiver operating characteristic (ROC) analysis, it was found that NLO ≥ 1.74 predicted minor head trauma with a sensitivity of 88% and specificity of 81% , while PLO was ≥ 108.1 predicted it with a sensitivity of 69% sensitivity and specificity of 67% .
Conclusions:The increase of NLO and PLO may be a guide for detecting the necessity of BT in minor head traumas.In addition, these parameters can also be helpful in choosing the treatment method to be applied if pathology is detected.

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