Evaluation of infants undergoing cranial computed tomography in the emergency department due to head trauma

Yıl 2019, Cilt: 1 Sayı: 3, 111 - 114, 23.12.2019

Ramazan Ünal , Dilek Atik Ahmet Erdur , Bensu Bulut , Hasan Çam Salih Fettahoğlu Ramazan Güven , Başar Cander

Öz

Pediatric head trauma is one of the most important
public health issues worldwide and is one of the most common causes of
morbidity and mortality in this age group. In infants, trauma of the same
severity with adults bring different outcomes as the body structure is
different compared to adults. Imaging methods are frequently used in infants
presenting with trauma, since children in the 0-2 age group cannot express
themselves, their neurological examination is limited and families of infants
cannot provide clear information about trauma. 
The best imaging method for trauma is cranial computed tomography (CCT).
In this study, patients aged 0-2 years who applied to an emergency department
of a training and research hospital in Istanbul between January 1, 2018 and
January 31, 2018 were examined retrospectively. The aim of this study was to
determine a clinical pathway by evaluating cranial computed tomography imagings
of 0-2 year-old pediatric patients brought to the emergency department for head
trauma. In our study, 523 patients aged 0-2 years were admitted for trauma
between the specified time period and 166 of these patients underwent CCT. Of
the patients who underwent CCT, 9% (n=15) were found to have pathology due to
trauma. Ten of these patients underwent follow-up CCT.  One of 15 patients was found to have bone
fracture. The other 14 patients were suspected of contusion. Of the patients
who underwent CCT, 3.1% (n=5) were admitted to the ward for follow-up.

When the patients were evaluated in terms of clinical
course, hospitalization or discharge in our study, they were found to correlate
with pathologies detected on CCT.

Due to the intensity of the patients in the emergency
department, sufficient time cannot be allocated for the examination and
informing of patients. It was observed that Cranial CT request frequency
increased especially between 16: 00-00: 00 hours when emergency department
intensity increased.

In infant trauma patients, imaging studies should be
determined considering the severity and mechanism of trauma.

Anahtar Kelimeler

head trauma, infant, computed tomography, emergency department

Kaynakça

• Bowman SM, Bird TM, Aitken ME, Tilford JM. Trends in hospitalizations associated with pediatric traumatic brain injuries. Pediatrics 2008;122:988-93.
• Tabish A, Lone NA, Afzal WM, Salam A. The incidence and severity of injury in children hospitalised for traumatic brain injury in Kashmir. Injury 2006;37:410-5.
• Dietrich AM, Bowman MJ, Ginn-Pease ME, Kosnik E, King DR. Pediatric head injuries: can clinical factors reliably predict an abnormality on computed tomography? Ann Emerg Med 1993; 22: 1535-40.
• Qauyle KS, Jaffe DM, Kuppermann N, Kaufman BA, Lee BC, Park TS, et al. Diagnostic testing for acute head injury in children: when are head computed tomography and skull radiographics indicated? Pediatrics.1997; 99: e11.
• Tintinalli J, Kelen GD, Stapczynski JS. Emergency Medicine, Comprehensive Study Guide. American Collage of Physicians. The McGraw-Hill Companies, Inc. Sixth edition, section 22, Pediatric trauma, P: 1545-6.
• Langlois JA, Rutland-Brown W, Thomas KE. Traumatic brain injury in the United States. Atlanta, GA: Centers for Disease Control and Prevention; 2006
• Beaudin M, Saint-Vil D, Ouimet A, Mercier C, Crevier L. Clinical algorithm and resource use in the management of children with minor head trauma. J Pediatr Surg 2007; 42: 849-52.
• Savitsky EA, Votey SR. Current controversies in the management of minor pediatric head injuries. Am J Emerg Med 2000; 18: 96-101.
• Langlois JA, Rutland-Brown W, Wald MM. The epidemiology and impact of traumatic brain injury: a brief overview. J Head Trauma Rehabil 2006;21:375-8.
• Ragnarsson KT. Traumatic brain injury research since the 1998 NIH Consensus Conference: accomplishments and unmet goals. J Head Trauma Rehabil 2006;21:379-87.
• Centers for Disease Control and Prevention (CDC). Statespecific prevalence of cigarette smoking among adults and quitting among persons aged 18-35 years--United States, 2006. MMWR Morb Mortal Wkly Rep 2007;56(38):993-6.
• Shane SA, Fuchs SM. Skull fractures in infants and predictors of associated intracranial injury. Pediatr Emerg Care 1997; 13: 198-203.
• Greenes DS, Schutzman SA. Clinical significance of scalp abnormalities in asymptomatic head-injured infants. Pediatr Emerg Care 2001; 17: 88-92.
• Brenner D, Elliston C, Hall E, Berdon W. Estimated risk of radiationinduced fatal cancer from pediatric CT. AJR Am J Roentgenol 2001; 176: 289-96.
• Brenner DJ. Estimating cancer risks from pediatric CT: going from the qualitative to the quantitative. Pediatric Radiol 2002; 32: 228-31. [CrossRef]
• Köksal Ö, Özeren G, Yenice H, Çildir E. Is Cranial Computerized Tomography Really Necessary for Infants With Minor Head Trauma? JAEM 2011: 56-9
• Türedi S, Hasanbasoğlu A, Gündüz A, Yandı M. Clinical desicion instruments for CT scan in minor head trauma. J Emerg Med 2008; 34: 253-9.