Düşme Sonrası Kafa Travması Geçiren Bebeklerde Hastaneye Yatış Oranları ve Radyolojik Bulgular

Öz

Amaç: Bu çalışmada, düşme sonucu kafa travması geçiren bebeklerde radyasyona maruz kalma endişesi nedeniyle bilgisayarlı tomografi (BT) taraması yapılmasının gerekliliğinin hastaneye yatış oranları değerlendirilerek belirlenmesi amaçlanmıştır. Materyal ve Metot: Bu çalışmaya 2018-2022 yılları arasında acil serviste pediatrik düşme nedeniyle kraniyal BT çekilen 1060 hasta dahil edildi. İki hasta tedavi reddi nedeniyle dışlandı. BT taramalarında kafatası kırıkları ve özellikleri ve ilişkili cilt bulguları ve intrakraniyal kanama, hastaların demografik özellikleri (yaş ve cinsiyet) ve tıbbi öyküleri, hastaneye yatış oranları araştırıldı. Bulgular: İkinci basamak merkezinin acil servisine başvuran 1058 kafa travmalı hastadan sadece 28'inde kırık tespit edildi. Bu hastaların %1,8'i yatarak tedavi edildi. Kırığı olan hastaların sırasıyla %10,7'sinde (n=3) subdural hematom ve %7,1'inde (n=2) epidural hematom tespit edilmiştir. Ayrıca, travma başvurularının sırasıyla %0,3'ünde ve %0,2'sinde subdural hematom ve epidural hematom tespit edildi. Sonuç: Sonuç olarak, incelenen hastalarda pozitif BT bulguları ve hastaneye yatış gerektiren hasta oranının düşüklüğü göze çarpmaktadır. Bu nedenle 0-2 yaş arasında tomografi istenirken dikkatli olunmalıdır.

Anahtar Kelimeler

• Bebek
• BT görüntüleme
• hastaneye yatış oranları
• kafatası kırığı
• kafa travması

Hospitalization rates and radiological findings in infants with head trauma after a fall

Öz

Objective: The study aimed to determine the necessity of performing computed tomography (CT) scans in infants with head trauma because of falls because of concerns regarding radiation exposure by evaluating the hospitalisation rates. Materials and Methods: The present study included 1060 patients who underwent cranial CT in the emergency department owing to a pediatric fall between 2018 and 2022. Two patients were excluded due to treatment refusal. Skull fractures, their characteristics, associated skin findings, and intracranial hemorrhage on CT scans and patients’ demographic features (age & sex), medical history, and hospitalisation rates were investigated. Results: Of the 1058 patients with head trauma who presented to the emergency department in the secondary care centre, fractures were detected in only 28 patients. Of these patients, 1.8% were treated as inpatients. Subdural hematomas and epidural hematomas were detected in 10.7% (n=3) and 7.1% (n=2) of patients with fractures, respectively. Furthermore, subdural hematomas and epidural hematomas were detected in 0.3% and 0.2% of trauma admissions, respectively. Conclusions: In conclusion, positive CT findings and a low percentage of patients requiring hospitalisation stand out in the patients examined. Therefore, care should be taken when requesting tomography between the ages of 0-2.

Anahtar Kelimeler

• skull fracture
• infant
• head trauma
• hospitalization rates

Kaynakça

1. 1. Ciurea AV, Gorgan MR, Tascu A, Sandu AM, Rizea RE. Traumatic brain injury in infants and toddlers, 0-3 years old. J Med Life. 2011;4(3):234-243.
2. 2. Niele N, van Houten MA, Boersma B, et al. Mul-ti-centre study found that strict adherence to gui-delines led to computed tomography scans being overused in children with minor head injuries. Acta Paediatr. 2019;108(9):1695-1703. doi:10.1111/apa.14742
3. 3. Noje C, Jackson EM, Nasr IW, et al. Trauma Bay Disposition of Infants and Young Children With Mild Traumatic Brain Injury and Positive Head Imaging. Pediatr Crit Care Med. 2019;20(11):1061-1068. doi:10.1097/pcc.0000000000002033
4. 4. Kopelman TR, Berardoni NE, O'Neill PJ, et al. Risk factors for blunt cerebrovascular injury in children: do they mimic those seen in adults? J Trauma. 2011;71(3):559-564. doi:10.1097/TA.0b013e318226eadd
5. 5. Horswell BB, Jaskolka MS. Pediatric head in-juries. Oral Maxillofac Surg Clin North Am. 2012;24(3):337-350. doi:10.1016/j.coms.2012.05.003
6. 6. Bonfield CM, Naran S, Adetayo OA, Pollack IF, Losee JE. Pediatric skull fractures: the need for surgical intervention, characteristics, complicati-ons, and outcomes. J Neurosurg Pediatr. 2014(2);14:205-211. doi:10.3171/2014.5.Peds13414
7. 7. Brown CW, Akbar SP, Cooper JG. Things that go bump in the day or night: the aetiology of in-fant head injuries presenting to a Scottish Paedi-atric Emergency Department. Eur J Emerg Med. 2014;21(6):447-450. doi:10.1097/mej.0000000000000125
8. 8. Muñoz-Santanach D, Trenchs Sainz de la Maza V, González Forster E, Luaces Cubells C. Child-ren with minor head injury in the emergency de-partment: Is skull radiography necessary for children under 2 years? Neurocirugia (Astur). 2014;25(4):149-153. doi:10.1016/j.neucir.2014.05.002

9. 9. Gravel J, Gouin S, Chalut D, et al. Derivation and validation of a clinical decision rule to iden-tify young children with skull fracture following isolated head trauma. CMAJ. 2015;187(16):1202-1208. doi:10.1503/cmaj.150540
10. 10. Powell EC, Atabaki SM, Wootton-Gorges S, et al. Isolated linear skull fractures in children with blunt head trauma. Pediatrics. 2015;135(4):e851-857. doi:10.1542/peds.2014-2858
11. 11. Samuel N, Jacob R, Eilon Y, Mashiach T, Shavit I. Falls in young children with minor head injury: A prospective analysis of injury mechanisms. Brain Inj. 2015;29(7-8):946-950. doi:10.3109/02699052.2015.1017005
12. 12. Thiam DW, Yap SH, Chong SL. Clinical deci-sion rules for paediatric minor head injury: Are CT scans a necessary evil? Ann Acad Med Sin-gap. 2015;44(9):335-341.
13. 13. Tilma IS, Bekhof J, Brand PL. Mild traumatic brain injury in children: Can we predict intracra-nial complications? Ned Tijdschr Geneeskd. 2015;159:A8405.
14. 14. Blackwood BP, Bean JF, Sadecki-Lund C, Hele-nowski 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. doi:10.1016/j.jpedsurg.2015.08.064
15. 15. Tallapragada K, Peddada RS, Dexter M. Paediat-ric mild head injury: Is routine admission to a tertiary trauma hospital necessary? ANZ J Surg. 2018;88(3):202-206. doi:10.1111/ans.14175
16. 16. Hill CS, McLean AL, Wilson MH. Epidemiology of Pediatric Traumatic Brain Injury in a Dense Urban Area Served by a Helicopter Trauma Ser-vice. Pediatr Emerg Care. 2018;34(6):426-430. doi:10.1097/pec.0000000000000845
17. 17. Patel SK, Gozal YM, Krueger BM, et al. Routine surveillance imaging following mild traumatic brain injury with intracranial hemorrhage may not be necessary. J Pediatr Surg. 2018;53(10):2048-2054. doi:10.1016/j.jpedsurg.2018.04.027
18. 18. Hajiaghamemar M, Lan IS, Christian CW, Coats B, Margulies SS. Infant skull fracture risk for low height falls. Int J Legal Med. 2019;133(3):847-862. doi:10.1007/s00414-018-1918-1
19. 19. Ruiz-Maldonado TM, Alsanea Y, Coats B. Age-related skull fracture patterns in infants after low-height falls. Pediatr Res. 2022. doi:10.1038/s41390-022-02345-9
20. 20. Hanalioglu S, Hanalioglu D, Elbir C, et al. A novel decision-support tool (IniCT Score) for repeat head computed tomography in pediatric mild traumatic brain injury. World Neurosurg. 2022;165:e102-e109. doi:10.1016/j.wneu.2022.05.103