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Hafif Travmatik Beyin Yaralanması olan Çocuklarda Rutin Olarak Çekilen İkinci Bilgisayarlı Beyin Tomografisinin Radyolojik ve Klinik Sonuçları

Yıl 2021, Cilt: 26 Sayı: 3, 271 - 276, 27.09.2021
https://doi.org/10.21673/anadoluklin.878492

Öz

Amaç: Bu çalışmada ilk bilgisayarlı beyin tomografisinde (BBT) hafif travmatik beyin yaralanması (TBY) olan çocuklarda rutin olarak çekilen ikinci BBT’nin tedavi yaklaşımına katkısını değerlendirmek amaçlanmıştır.
Yöntem: Retrospektif çalışmamız Ağustos 2010—Ağustos 2014 döneminde pediyatrik acil servisimizde hafif TBY’li çocuklar arasından ilk BBT’sinde travmatik lezyon görülen ve rutin olarak ikinci kez BBT çekilen hastalarla gerçekleştirildi. Hasta verileri (yaş ve cinsiyet, travma mekanizması, belirtiler, fizik muayene bulguları, ilk ve ikinci BBT bulguları, iki BBT arasındaki süre, medikal ve cerrahi tedaviler) kaydedildi.
Bulgular: Çalışma, dahil edilme kriterlerini sağlayan ve %57,5’i erkek olan toplam 113 hasta içerdi. Ortanca hasta yaşı 28 (çeyrekler arası aralık: 6,5–80) ay idi. Hastaların 72’si (%63,7) hastaneye kabul sırasında asemptomatikti ve 54 (%47,8) hastada bir fizik muayene bulgusu yoktu. Travmatik lezyonların %64,9’u lineer kafatası fraktürü, %13,7’si subdural hematom, %13’ü kontüzyon, %3,8’i subaraknoid
kanama, %3’ü epidural hematom, %0,8’i intraparankimal kanama, %0,8’i çökme fraktürü idi. Rutin ikinci BBT 11±2,5 saat sonra çekilmiş ve hastaların %6,2’sinde ilerleme ortaya koymuştu. Sonrasında medikal ya da nörocerrahi tedavide bir değişiklik olmamıştı.
Sonuç: Acil servisimizde rutin olarak tekrarlanan BBT’de ilerleme oranı %6,2 olmakla birlikte uygulanan medikal ve nörocerrahi tedavilerde bir değişiklik olmamıştır.

Destekleyen Kurum

yok

Kaynakça

  • Chen C, Peng J, Sribnick EA, Zhu M, Xiang H. Trend of age-adjusted rates of pediatric traumatic brain injury in U.S. emergency departments from 2006 to 2013. Int J Environ Res Public Health. 2018;15(6):1171.
  • Coulter IC, Forsyth RJ. Paediatric traumatic brain injury. Curr Opin Pediatr. 2019;31(6):769–74.
  • Capizzi A, Woo J, Verduzco-Gutierrez M. Traumatic brain injury: an overview of epidemiology, pathophysiology, and medical management. Med Clin North Am. 2020;104(2):213–38.
  • Kuppermann N, Holmes JF, Dayan PS, Hoyle JD Jr, Atabaki SM, Holubkov R, et al. Identification of children at very low risk of clinically-important brain injuries after head trauma: a prospective cohort study. Lancet. 2009;374(9696):1160–70.
  • Bata SC, Yung M. Role of routine repeat head imaging in paediatric traumatic brain injury. ANZ J Surg. 2014;84(6):438–41.
  • Araki T, Yokota H, Morita A. Pediatric traumatic brain injury: characteristic features, diagnosis, and management. Neurol Med Chir. 2017;57(2):82–93.
  • Durham SR, Liu KC, Selden NR. Utility of serial computed tomography imaging in pediatric patients with head trauma. J Neurosurg. 2006;105(Suppl. 5):365–9.
  • Givner A, Gurney J, O’Connor D, Kassarjian A, Lamorte WW, Moulton S. Reimaging in pediatric neurotrauma: factors associated with progression of intracranial injury. J Pediatr Surg. 2002;37(3):381–5.
  • Tabori U, Kornecki A, Sofer S, Constantini S, Paret G, Beck R, et al. Repeat computed tomographic scan within 24–48 hours of admission in children with moderate and severe head trauma. Crit Care Med. 2000;28(3):840–4.
  • Dawson EC, Montgomery CP, Frim D, Koogler T. Is repeat head computed tomography necessary in children admitted with mild head injury and normal neurological exam? Pediatr Neurosurg. 2012;48(4):221–4.
  • Howe J, Fitzpatrick CM, Lakam DR, Gleisner A, Vane DW. Routine repeat brain computed tomography in all children with mild traumatic brain injury may result in unnecessary radiation exposure. J Trauma Acute Care Surg. 2014;76(2):292–5.
  • Hollingworth W, Vavilala MS, Jarvik JG, Chaudhry S, Johnston BD, Layman S, et al. The use of repeated head computed tomography in pediatric blunt head trauma: factors predicting new and worsening brain injury. Pediatr Crit Care Med. 2007;8(4):348–56.
  • Figg RE, Stouffer CW, Kolk WEV, Connors RH. Clinical efficacy of serial computed tomographic scanning in pediatric severe traumatic brain injury. Pediatr Surg Int. 2006;22(3):215–8.
  • Schnellinger MG, Reid S, Louie J. Are serial brain imaging scans required for children who have suffered acute intracranial injury secondary to blunt head trauma? Clin Pediatr. 2010;49(6):569–73.
  • Goodman TR, Mustafa A, Rowe E. Pediatric CT radiation exposure: where we were, and where we are now. Pediatr Radiol. 2019;49(4):469–78.
  • Ideguchi R, Yoshida K, Ohtsuru A, Takamura N, Tsuchida T, Kimura H, et al. The present state of radiation exposure from pediatric CT examinations in Japan—what do we have to do? J Radiat Res. 2018;59(suppl. 2):ii130–6.
  • Aziz H, Rhee P, Pandit V, Ibrahim-Zada I, Kulvatunyou N, Wynne J, et al. Mild and moderate pediatric traumatic brain injury: replace routine repeat head computed tomography with neurologic examination. J Trauma Acute Care Surg. 2013;75(4):550–4.
  • Yilmaz H, Yilmaz O. Follow-up computed tomography requirement of pediatric head trauma patients with abnormal imaging findings. World Neurosurg. 2019;124:e764–8.
  • da Silva PS, Reis ME, Aguiar VE. Value of repeat cranial computed tomography in pediatric patients sustaining moderate to severe traumatic brain injury. J Trauma. 2008;65(6):1293–7.
  • Stein SC, Spettell CM. Delayed and progressive brain injury in children and adolescents with head trauma. Pediatr Neurosurg. 1995;23(6):299–304.

The Radiological and Clinical Outcomes of Routinely Performed Second Head Computed Tomography in Children with Mild Traumatic Brain Injury

Yıl 2021, Cilt: 26 Sayı: 3, 271 - 276, 27.09.2021
https://doi.org/10.21673/anadoluklin.878492

Öz

Aim: In this study, we aimed to assess how the routine use of a second head computed tomography (CT) scan contributed to therapeutic approach in children diagnosed with mild traumatic brain injury (TBI).
Methods: The retrospective study included children with mild TBI who had traumatic lesions on initial head CT and underwent a second CT scan as performed routinely at our pediatric emergency department between August 2010 and August 2014. Patient data (age and sex, mechanism of trauma, symptoms, physical examination findings, results of the first and second head CT scans, time between the two scans, and medical and surgical treatments) were recorded.
Results: A total of 113 patients met the inclusion criteria and 57.5% of them were male. The median patient age was 28 (interquartile range: 6.5–80) months. Seventy-two (63.7%) patients were asymptomatic on admission and there was no finding on physical examination in 54 (47.8%) patients. Of all traumatic lesions, 64.9% were linear skull fracture, 13.7% subdural hematoma, 13% contusion, 3.8% subarachnoid hemorrhage, 3% epidural hematoma, 0.8% intraparenchymal hemorrhage, and 0.8% depressed skull fracture. The routine second head CT scans were performed after 11±2.5 hours and revealed progression in 6.2% of the patients. No subsequent change in medical treatment or neurosurgical intervention occurred.
Conclusion: Although the progression rate in routinely repeated CT at our emergency department was 6.2%, there was no change in the medical and neurosurgical interventions performed.

Kaynakça

  • Chen C, Peng J, Sribnick EA, Zhu M, Xiang H. Trend of age-adjusted rates of pediatric traumatic brain injury in U.S. emergency departments from 2006 to 2013. Int J Environ Res Public Health. 2018;15(6):1171.
  • Coulter IC, Forsyth RJ. Paediatric traumatic brain injury. Curr Opin Pediatr. 2019;31(6):769–74.
  • Capizzi A, Woo J, Verduzco-Gutierrez M. Traumatic brain injury: an overview of epidemiology, pathophysiology, and medical management. Med Clin North Am. 2020;104(2):213–38.
  • Kuppermann N, Holmes JF, Dayan PS, Hoyle JD Jr, Atabaki SM, Holubkov R, et al. Identification of children at very low risk of clinically-important brain injuries after head trauma: a prospective cohort study. Lancet. 2009;374(9696):1160–70.
  • Bata SC, Yung M. Role of routine repeat head imaging in paediatric traumatic brain injury. ANZ J Surg. 2014;84(6):438–41.
  • Araki T, Yokota H, Morita A. Pediatric traumatic brain injury: characteristic features, diagnosis, and management. Neurol Med Chir. 2017;57(2):82–93.
  • Durham SR, Liu KC, Selden NR. Utility of serial computed tomography imaging in pediatric patients with head trauma. J Neurosurg. 2006;105(Suppl. 5):365–9.
  • Givner A, Gurney J, O’Connor D, Kassarjian A, Lamorte WW, Moulton S. Reimaging in pediatric neurotrauma: factors associated with progression of intracranial injury. J Pediatr Surg. 2002;37(3):381–5.
  • Tabori U, Kornecki A, Sofer S, Constantini S, Paret G, Beck R, et al. Repeat computed tomographic scan within 24–48 hours of admission in children with moderate and severe head trauma. Crit Care Med. 2000;28(3):840–4.
  • Dawson EC, Montgomery CP, Frim D, Koogler T. Is repeat head computed tomography necessary in children admitted with mild head injury and normal neurological exam? Pediatr Neurosurg. 2012;48(4):221–4.
  • Howe J, Fitzpatrick CM, Lakam DR, Gleisner A, Vane DW. Routine repeat brain computed tomography in all children with mild traumatic brain injury may result in unnecessary radiation exposure. J Trauma Acute Care Surg. 2014;76(2):292–5.
  • Hollingworth W, Vavilala MS, Jarvik JG, Chaudhry S, Johnston BD, Layman S, et al. The use of repeated head computed tomography in pediatric blunt head trauma: factors predicting new and worsening brain injury. Pediatr Crit Care Med. 2007;8(4):348–56.
  • Figg RE, Stouffer CW, Kolk WEV, Connors RH. Clinical efficacy of serial computed tomographic scanning in pediatric severe traumatic brain injury. Pediatr Surg Int. 2006;22(3):215–8.
  • Schnellinger MG, Reid S, Louie J. Are serial brain imaging scans required for children who have suffered acute intracranial injury secondary to blunt head trauma? Clin Pediatr. 2010;49(6):569–73.
  • Goodman TR, Mustafa A, Rowe E. Pediatric CT radiation exposure: where we were, and where we are now. Pediatr Radiol. 2019;49(4):469–78.
  • Ideguchi R, Yoshida K, Ohtsuru A, Takamura N, Tsuchida T, Kimura H, et al. The present state of radiation exposure from pediatric CT examinations in Japan—what do we have to do? J Radiat Res. 2018;59(suppl. 2):ii130–6.
  • Aziz H, Rhee P, Pandit V, Ibrahim-Zada I, Kulvatunyou N, Wynne J, et al. Mild and moderate pediatric traumatic brain injury: replace routine repeat head computed tomography with neurologic examination. J Trauma Acute Care Surg. 2013;75(4):550–4.
  • Yilmaz H, Yilmaz O. Follow-up computed tomography requirement of pediatric head trauma patients with abnormal imaging findings. World Neurosurg. 2019;124:e764–8.
  • da Silva PS, Reis ME, Aguiar VE. Value of repeat cranial computed tomography in pediatric patients sustaining moderate to severe traumatic brain injury. J Trauma. 2008;65(6):1293–7.
  • Stein SC, Spettell CM. Delayed and progressive brain injury in children and adolescents with head trauma. Pediatr Neurosurg. 1995;23(6):299–304.
Toplam 20 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Sağlık Kurumları Yönetimi
Bölüm ORJİNAL MAKALE
Yazarlar

Anıl Er 0000-0003-3452-5123

Aykut Çağlar 0000-0002-2805-5420

Fatma Akgül 0000-0002-6503-2279

Emel Ulusoy 0000-0002-2827-1553

Murat Duman 0000-0001-6767-5748

Durgül Yılmaz 0000-0002-4944-2913

Yayımlanma Tarihi 27 Eylül 2021
Kabul Tarihi 29 Mayıs 2021
Yayımlandığı Sayı Yıl 2021 Cilt: 26 Sayı: 3

Kaynak Göster

Vancouver Er A, Çağlar A, Akgül F, Ulusoy E, Duman M, Yılmaz D. The Radiological and Clinical Outcomes of Routinely Performed Second Head Computed Tomography in Children with Mild Traumatic Brain Injury. Anadolu Klin. 2021;26(3):271-6.

13151 This Journal licensed under a CC BY-NC (Creative Commons Attribution-NonCommercial 4.0) International License.