How necessary is computed tomography in pediatric minor head trauma?

Abstract

ABSTRACT Computerized tomography (CT) is very often used for head injury. Especially in child¬hood as related to the use of CT is known that a number of drawbacks. At the age of fifteen and under with minor head trauma, it is very difficult to assess whether CT is necessary. The purpose of this study was to assess the necessarity of CT in children who are at 15 years of age and under with minor head trauma. The records of 115 cases who applied with minor head trauma between October 2010-June 2011 to Nevşehir State Hos¬pital Emergency Department, were examined retrospectively. Cases who are 15 years of age and under, with a score of Glascow Coma Scale 15, with a normal neurological examination and applied to emergency service after falls (falls from height, falling from a bicycle, falling on leisure activities), motor vehicle accident, crash and assault were included to study. Forty three (37.4%) were female and 72 (62.6%) were male, while the average age was 7. Among the symptoms, vomiting was the most frequent with 30.4%, while headache was in second place with 19.1%. When we look at the findings, soft tissue swelling was 29.6% in the first place. In all cases CT was taken. Ninety seven (84.4%) patients had normal CTs, while 18 (15.6%) patients had pathology in cranial CT. In cases with pathological cranial CT, 11 (61.1%) patients had linear fracture, 5 (27.7%) patients had depressed fractures, 1 (5.5%) patient had subdural hematoma plus linear fracture and 1 (5.5%) patient had plastering epidural hematoma. In these patients with pathologic cranial CT, 5 (27.7%) of them, (overall 4.3%) underwent surgery. In this study 29.4% of all patients with soft tissue swelling, and 83.3% of all patient with deep incision had pathological cranial CT. There were statistically significant difference between presence of soft tissue swelling, deep incision and pathological cranial CT. (Respectively p = 0.009 and p = 0.001). In children 15 years age and under with minor head trauma, cranial CT should be taken in the presence of soft tissue swelling and deep incision in physical ex¬amination. J. Exp. Clin. Med., 2011; 28:107-110

Keywords

• -

References

1. Beaudin, M., Saint-Vil, D., Ouimet, A., 2007. Clinical algorithm and resource use in the management of children with minor head trauma. J. Pediatr. Surg. 42, 849-852.
2. Bergman, D.A., Baltz, D.R., Coolye, J.R., 1999. The management of minor closed head injury in children. Pediatr. 104, 1407-1416.
3. Borzcuk, P., 1995. Predictors of Intracranial Injury in patients with Mild Head Injury. Ann. Emerg. Med. 25,731.
4. Infante-Rivard, C., Mathonnet, G., Sinnett, D., 2000. Risk of childhood leukemia associated with diagnostic irradiation and polymorphisms in DNA repair genes. Environ. Health Perspect. 108, 495–498.
5. Dacey, R.G., Alves, W.M., Rimel, R.W., 1986. Neurosurgical complications after apparently minor head injury: Assessment of risk in a series of 610 patients. J. Neurosurg. 65, 203-210.
6. David, J., Phil, D., Eric, J., 2007. Computed Tomography - An Increasing source of radiation exposure. N. Engl. J. Med. 357, 2277-2284.
7. Dietrich, A.M., Bowman, M.J., Ginn-Pease, M.E., 1993. Pediatric head injuries: can clinical factors reliably predict an abnormality on computed tomography? Ann. Emerg, Med. 22, 1535-1540.
8. Duus, B.R., Lind, B.,Christensen, H., 1994. The role of neuroimaging in the initial management of patients with minor head injury. Ann. Emerg. Med. 23, 1279.

9. Gutman, M.B., Moulton, R.J., Sullivan, I., 1992. Risck factors predicting operable intracranial hematomas in head injury. J. Neurosurgry. 77, 9.
10. Haydel, M.J., Shembekar, A.D., 2003. Prediction of intracranial injury in children aged five years and older with loss of consciousness after minor head injury due to nontrivial mechanisms. Ann. Emerg. Med. 42, 507-514.
11. Kirsch, T.D., Migliore, S., Hogan, T.M., 2000. Head injury in: Emergency medicine, 5th edition. New York: McGraw Hill. 1631– 1645.
12. Miller, E.C., Derlet, W.R., Kinser, D., 1995. Minor head trauma is computed tomography always necessary? Ann. Emerg. Med. 27, 290.
13. Quayle, K.S., 1999. Minor head injury in the pediatric patient. Pediatr. Clin. North. Am. 46, 1189-1199.
14. Quayle, K.S., Jaffe, D.M., Kuppermann, N., 1997. Diagnostic testing for acute head injury in children: when are head computed tomography and skull radiographics indicated? Pediatrics. 99, 11.
15. Rivara, F.P., Calonge, N., Thompson, R.S., 1989. Population - based study of unintentional injury incidence and impact during childhood. Am. J. Public. Health. 79, 990-994.
16. Savitsky, E.A., Votey, S.R., 2000. Current controversies in the management of minor pediatric head injuries. Am. J. Emerg. Med. 18, 96 -101.
17. Schnadower, D., Vazquez, H., Lee, J., 2007. Controversies in the evaluation and management of minor blunt head trauma in children. Curr. Opin. Pediatr. 19, 258-264.
18. Schunk, J.E., Rodgerson, J.D., Woodward, G.A., 1996. The utility of head computed tomographic scanning in pediatric patients with normal neurologic examination in the emergency department. Ped. Emerg. Care. 12, 260.
19. Stein, S.C., Ross, S.E., 1992. Mild head injury: A plea for poutine early CT scanning. J. Trauma. 33,11.
20. Tintinalli, J., Kelen, G.D., Stapczynski, J.S., 2004. Emergency medicine, Comprehensive study guide american college of physicians. The McGraw-Hill Companies, Inc. Sixth edition, section 22, Pediatric trauma, pp: 1545-1546.
21. Türedi, S., Hasanbasoğlu, A., Gündüz, A., 2008. Clinical desicion instruments for CT scan in minor head trauma. J. Emerg. Med. 34, 253-259.