Acil serviste tespit edilen çocukluk çağı kafa tası kırıklarının mortalite ve morbiditesinin incelenmesi

Year 2021, Volume: 14 Issue: 2, 137 - 143, 30.08.2021

Mustafa Boğan Hasan Baki Altınsoy Murat Oktay

https://doi.org/10.52976/vansaglik.773020

Abstract

Amaç: Kafatası kırıkları çocukluk çağında sık görülen yaralanmalardandır, basit travmalarla oluşan izole lineer kırıklardan yüksek enerjili travmalara oluşan intrakraniyal kanamayı da içeren çökme kırıklarına kadar değişen derecelerde görülebilmektedir. Bu çalışmanın amacı kafa travması sonrası acil servise başvuran, 16 yaş ve altı çocuklarda tespit edilen kafatası kırıklarının mortalite ve morbiditesini araştırmaktır.
Materyal ve Metot: Kafatası kırığı nedeniyle travma ünitesine alınan 16 yaş ve altı çocuk hastalar çalışmaya dahil edilmiştir.
Bulgular: Hastaların (toplam 113 vaka) yaş ortalaması 4,163,71 (0-15), %64,6’sı erkek ve geliş nedenleri en sık yüksekten düşmeydi (%69). Kafatası kırığı en sık sağ tarafta (%54), en sık frontal kemikte (%31) ve en sık lineer kırık (%78,8) izlenmiştir. Hastaların %68,1’inde kırığa eşlik eden intrakraniyal kanama izlenmemiştir. Travma ünitesinde takibe alınan hastaların ortalama yatış süreleri 3,424,52 (0-25) gündüz, 53 hastaya (%46,9) kontrol bilgisayarlı beyin tomografisi (BBT) çekilmiş, bunlardan 24(%45,3)’ünde kontrol BBT’de yeni gelişen intrakraniyal patoloji (6 hastada yeni gelişen kanama, 10 hastadan mevcut kanamda artış, 3 hastada yeni gelişen ödem, 4 hastada mevcut ödemde artış, bir hastada orta hat yapılarında yeni gelişen şift) izlenmiştir. 4 hasta nöroşirürjik operasyona alınırken, mortalite izlenmemiştir.
Sonuç: Çocukluk çağı kafa travmalarında radyolojik görüntülemede fraktür izlense dahi mortalite ve cerrahi oranları düşüktür. Ancak düşük GKS, deplase fraktür (çökme kırığı gibi) ve kırıkla birlikte olan kanamalar cerrahiye gidişi artırabilmektedir.

Keywords

kafa travması;, kafa tası kırığı;, çocukluk çağı;

Supporting Institution

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Project Number

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Thanks

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Investigation of mortality and morbidity of childhood skull fractures detected in the emergency department

Abstract

Objective: Skull fractures are common injuries in childhood, and it can be seen in varying degrees, ranging from simple traumas (such as falling from a parent's bed to a hard floor), isolated linear fractures, to high-energy traumas (such as falling from height, assault, traffic accident) and intracranial hemorrhage. The aim of this study is to investigate the mortality and morbidity of skull fractures detected in children under 16 years of age who applied to the emergency room after head trauma.
Material and Methods: Patients aged 16 and under who were taken to the trauma unit due to skull fracture were included in the study.
Results: The mean age of the patients (total of 113 cases) was 4.163.71 (0-15), 64.6% of them were male, and the reasons for their arrival were most frequently not falling from height (69%). The skull fracture was observed most frequently on the right side (54%), most often in the frontal bone (31%) and most frequently in the linear fracture (78.8%). In 68.1 % of patients, intracranial bleeding accompanying the fracture was not observed. The average length of hospitalization of patients who were followed-up in the trauma unit was 3.424.52 (0-25) during the day, 53 patients (46.9%) received control CCT, and 24 (45.3%) of them developed new control CCT. Intracranial pathology (new bleeding in 6 patients, increase in existing bleeding from 10 patients, newly developing edema in 3 patients, increase in existing edema in 4 patients, newly developing shift in midline structures in one patient). While 4 patients were taken to the neurosurgical operation, no mortality was observed.
Conclusion: Mortality and operation rates are low in childhood head trauma, even if fractures are observed in radiological imaging. However, low GCS, displaced fracture (such as collapse fracture) and bleeding associated with the fracture can increase the rate of surgery.

Keywords

head injury;, skull fracture;, childhood

Project Number

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References

• Alpar R. Uygulamlı İstatistitik ve Geçerlilik-Güvebirlik. Ankara: Detay yayınları, 2010
• Berthold O, Frericks B, John T, Clemens V, Fegert JM, Moers AV. Abuse as a Cause of Childhood Fractures. Dtsch Arztebl Int 2018;115(46):769-775.
• Blackwood BP, Bean JF, Sadecki-Lund C, Helenowski IB, Kabre R, Hunter CJ. Observation for isolated traumatic skull fractures in the pediatric population: unnecessary and costly. J Pediatr Surg 2016;51(4):654-658.
• Culotta PA, Crowe JE, Tran QA, et al. Performance of computed tomography of the head to evaluate for skull fractures in infants with suspected non-accidental trauma. Pediatr Radiol 2017;47(1):74-81.
• Er A, Akman C, Alataş İ, Ünlü HB, Ceylan I, Gün C. Minör Kafa Travması Olan Çocuklarda Rutin Olarak BT Yapmalı mıyız? JOPP Derg 2013; 5(3): 131-5
• Ersahin Y, Mutluer S, Mirzai H, Palali I. Pediatric depressed skull fractures: analysis of 530 cases. Childs Nerv Syst 1996; 12(6): 323-31.
• Gaw CE, Zonfrillo MR. Emergency department visits for head trauma in the United States. BMC Emerg Med 2016;16(1): 5.
• Hon KL, Huang S, Poon WS, Cheung HM, Ip P, Zee B. Mortality And Morbidity of Severe Traumatic Brain Injuries; A Pediatric Intensive Care Unit Experience Over 15 Years. Bull Emerg Trauma 2019; 7(3): 256.
• Kommaraju K, Haynes JH, Ritter AM. Evaluating the Role of a Neurosurgery Consultation in Management of Pediatric Isolated Linear Skull Fractures. Pediatr Neurosurg 2019; 54(1): 21-7.
• Kuppermann N, Holmes JF, Dayan PS.Identification of children at very low risk of clinically-important brain injuries after head trauma: a prospective cohort study Lancet 2009;374(9696):1160
• Levi L, Guilburd JN, Linn S, Feinsod M. The association between skull fracture, intracranial pathology and outcome in pediatric head injury. Br J Neurosurg 1991; 5(6): 617-625.
• Mannix R, Monuteaux MC, Schutzman SA, et al. Isolated skull fractures: trends in management in US pediatric emergency departments. Ann Emerg Med 2013; 62(4): 327-331.
• Ongun EA, Dursun O. Çocukluk çağı kafa travması olgularında mortaliteye etki eden faktörler: Üçüncü basamak çocuk yoğun bakım ünitesi uygulamaları. Ulus Travma Acil Cerrahi Derg 2018; 24(3): 199-206.
• Osmond MH, Klassen TP, Wells GA, et al. CATCH: a clinical decision rule for the use of computed tomography in children with minor head injury. CMAJ 2010; 182: 341-8
• Osmond MH, Klassen TP, Wells GA, et al. 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 2018; 190(27): E816-E822.
• Rus D, Chereches RM, Peek-Asa C, et al. Paediatric head injuries treated in a children's emergency department from Cluj-Napoca, Romania. Int J Inj Contr Saf Promot 2016; 23(2): 206-13.
• Williams DC, Selassie AW, Russell WS, Borg KT, Basco JrWT. Risk factors for admission and prolonged length of stay in pediatric isolated skull fractures. Pediatr Emerg Care 2017; 33(12): e146-e151.
• Yılmaz ER, Hastürk AE, Kahiloğulları G. Acil serviste kafa travması nedeni ile değerlendirilen 1114 hastanın epidemiyolojik incelemesi. Türk Nöroşir Derg 2012; 21: 242-5.