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

Year 2021, Volume: 11 Issue: 5, 589 - 594, 17.09.2021

Metin Ocak Semih Akar

https://doi.org/10.16899/jcm.914518

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

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