Evaluation of Pediatric Patients Admitted to the Emergency Department with Head Trauma

Abstract

Aim: Head trauma is the most frequent reason for trauma related child deaths. Minor head traumas (MHT) form a considerable part of pediatric head traumas. Computed Brain Tomography (CBT) is the gold standard for demonstrating intracranial pathologies in patients with head trauma. It is necessary to avoid having unnecessary CT scans in order to reduce the cost and the harms of radiation. We aim to assess the pediatric patients that applied to the emergency service with complaints of head trauma in the light of Prediction of Important Clinical Events (CHALICE) clinical decision-making rules. Materials and Methods: 200 patients under 18 years old who applied to the emergency service with complaints of head trauma between 2016 and 2019 are included in this retrospective study. Results: 200 patients in total were included in the study; of them, 128 are males and 72 are females. Of the patients, 3 have a Glaskow Coma Score (GCS) of 3-8, 2 have a GCS of 9-13, and the remaining 195 patients have a GCS of 14-15. Considering the symptoms, 35 patients had a headache, 28 patients had subcutaneous hematoma, and 26 patients had nausea-vomiting. The reason for trauma is motor vehicle accident for 99 patients and falling down from height for 95 patients. Four patients died. CHALICE (+) rate was found 67.82% in the patients having a CBT scan. 41.95% of asymptomatic patients had a CBT scan. Conclusion: The results of our study showed that despite all academic efforts, unnecessary CT rates in pediatric head injuries could not be reduced.

Keywords

• Pediatric Head Trauma
• CHALICE
• Computed Brain Tomography
• Defensive Medicine
• Traumatic Brain Damage
• Minor Head Trauma

Acil Servise Kafa Travmasi Nedeniyle Başvuran Çocuk Hastalarin Değerlendirilmesi

Abstract

Amaç: Kafa travması travmaya bağlı çocuk ölümlerinin en sık sebebidir. Minör kafa travmaları (MKT) çocukluk kafa travmalarının önemli bir kısmını oluşturmaktadır. Bilgisayarlı Beyin Tomografisi (BBT) kafa travması ile gelen hastalarda intrakraniyal patolojileri göstermek için altın standarttır. Ancak MKT’lerin küçük bir kısmında ciddi kafa içi hadise olduğu düşünüldüğünde maliyet ve radyasyonun zararlarını azaltmak için gereksiz tomografi çekmekten kaçınmak gerekir. Biz bu çalışmada acil servise kafa travması ile başvuran çocuk hastaları CHALICE klinik karar verme kuralları ışığında değerlendirmeyi amaçladık. Gereç ve Yöntem: Bu retrospektif çalışmaya 2016-2019 tarihleri arasında 18 yaş altında acil servise kafa travması nedeniyle başvuran 200 çocuk hasta dahil edilmiştir. Bulgular: Çalışmaya 128 erkek ve 72 kız olmak üzere toplam 200 hasta alınmıştır. Bunlardan 3’ünün GKS 3-8 arasında, 2’sinin GKS 9-13 arasında ve kalan 195 hastanın GKS 14-15 arasındadır. Semptomlara bakıldığında ise 35 hastada baş ağrısı, 28 hastada cilt altı hematom ve 26 hastada bulantı-kusma görülmüştür. Travma şekli 99 hastada araç içi trafik kazası ve 95 hastada yüksekten düşme şeklindedir. 39 hasta hastaneye yatırılarak tedavi edilmiştir. exitus olan 4 hasta vardır. BBT çekilenlerde CHALICE (+) oranı %67,82 olarak tespit edilmiştir. Hiçbir semptomu olmayan hastaların %41.95’ine BBT çekilmiştir. Sonuç: Çalışmamızın sonuçları, tüm akademik çabalara rağmen, çocuk kafa travmalarında gereksiz BT oranlarının azaltılamadığını göstermiştir.

Keywords

• Çocuk Kafa Travması
• CHALICE
• Bilgisayarlı Beyin Tomografisi
• Defansif Tıp
• Travmatik Beyin Hasarı
• Minor Kafa Travması

References

1. 1. Isık HS, Gökyar A, Yıldız Ö, Bostancı U, Ozdemir C. Pediatric head injuries, retrospective analysis of 851 patients: an epidemiological study [in Turkish]. Ulus Travma Acil Cerrahi Derg. 2011;17(2):166–172.
2. 2. Yasar S, Kırık A, Durmaz MO. Pediatric head traumas: A different perspective. Ulus Travma Acil Cerrahi Derg. 2020;26:765-768
3. 3. Duhaime AC, Christian CW, Rorke LB, Zimmerman RA. Nonaccidental head injury in infants--the “shaken-baby syndrome”. N Engl J Med 1998;338:1822−9.
4. 4. Greenberg JK, Jeffe DB, Carpenter CR, Yan Y, Pineda JA, Lumba-Brown A, et al. North American survey on the post-neuroimaging management of children with mild head injuries. J Neurosurg Pediatr. 2018;23:227−35.
5. 5. Gizli G, Durak VA, Koksal O. The comparison of PECARN, CATCH, AND CHALICE criteria in children under the age of 18 years with minor head trauma in emergency department. Hong Kong Journal of Emergency Medicine. 2020:1-7
6. 6. Hebb MO, Clarke DB and Tallon JM. Development of a provincial guideline for the acute assessment and management of adult and pediatric patients with head injuries. Can J Surg. 2007; 50: 187–194.
7. 7. Stiell IG, Wells GA, Vandemheen K, et al. Variation in ED use of computed tomography for patients with minor head injury. Ann Emerg Med. 1997; 30(1): 14–22.
8. 8. Brenner DJ. Estimating cancer risks from pediatric CT: going from the qualitative to the quantitative. Pediatr Radiol 2002;32(4):228-31.

9. 9. McGraw M, Way T. Comparison of PECARN, CATCH, and CHALICE clinical decision rules for pediatric head injury in the emergency department. CJEM. 2019;21(1): 120-4
10. 10. Food and Drug Administration. FDA Public Health Notification. Pediatr Radiol. 2002;32:314–316
11. 11. Nigrovic LE and Kuppermann N. Children With Minor Blunt Head Trauma Presenting to theEmergency Department. Pediatrics. 2019;144(6): e201914
12. 12. Dunning J, Daly JP, Lomas J-PP, Lecky F, Batchelor J, Mackway-Jones K; Children’s Head Injury Algorithm for the Prediction of Important Clinical Events Study Group. Derivation of the children’s head injury algorithm for the prediction of important clinical events decision rule for head injury in children. Arch Dis Child. 2006;91(11): 885–891
13. 13. Kessler D, McClellan M. Do doctors practice defensive medicine? The Quarterly Journal of Economics. 1996; 111(2): 353-90.
14. 14. Yeşiltaş A, Erdem R. A Revıew On Defensıve Medıcal Applıcatıons. Suleyman Demirel University Visionary Journal. 2019; 10 (23): 137-150
15. 15. Bozan Ö, Aksel G, Kahraman HA, Giritli Ö, Eroğlu SE. Comparison of PECARN and CATCH clinical decision rules in children with minor blunt head trauma. Eur J Trauma Emerg Surg. 2019; 45:849–855
16. 16. Dunning J, Daly JP, Lomas JP, Lecky F, Batchelor J, Mackway- Jones K. Children’s head injury algorithm for the prediction of important clinical events study group. Derivation of the children’s head injury algorithm for the prediction of important clinical events decision rule for head injury in children. Arch Dis Child.2006;91(11):885–91.
17. 17. Palchak MJ, Holmes JF, Vance CW, Gelber RE, Schauer BA, Harrison MJ, Willis-Shore J, Wootton-Gorges SL, Derlet RW, Kuppermann N. Does an isolated history of loss of consciousness or amnesia predict brain injuries in children after blunt head trauma? Pediatrics. 2004;113(6):e507–13.
18. 18. Atabaki SM, Stiell IG, Bazarian JJ, Sadow KE, Vu TT, Camarca MA, Berns S, Chamberlain JM. A clinical decision rule for cranial computed tomography in minor pediatric head trauma. Arch Pediatr Adolesc Med. 2008;162(5):439–45.
19. 19. Atabaki SM. Pediatric Head Injury. Pediatrics in Review. 2007;28;215-25