Skull radiographs and computed tomography scans in children and adolescents with mild head trauma

Abstract

-Objective:To identify which pediatric patients with mild head trauma are candidates for skull radiographs or cranial computed tomography (CCT) scans. Method: Patients with mild head trauma aged from 0 to 19 years presenting to the Emergency Department of a trauma centre from Salvador City, Brazil, between May 2007 and May 2008. Results: A total of 1888 mild head trauma patients were admitted; mean age was 7.4 (±5.5) years. A total of 1956 skull radiographs and 734 CCT scans were performed. About 44.4% patients with Glasgow coma score (GCS) 13 and 55.4% with GCS 14 had abnormal CCT scans. In patients with multiple traumas, 16% had abnormal findings on CCT scans. Conclusion: We strongly recommend routine CCT studies to patients with GCS of 13 and 14 or to multiple trauma victims, independently of score. Routine screening skull radiographs were not useful in the evaluation of mild head trauma patients in this study.KEy WoRDS: tomography, radiography, traumatic injury brain, child, adolescent. radiografia simples e tomografia computadorizada do crânio em crianças e adolescentes vítimas de traumatismo craniano leveResumo -Objetivo: Identificar quais os pacientes na faixa pediátrica com trauma craniencefálico leve são candidatos para a realização de radiografia simples ou tomografia computadorizada do crânio (TCC). Método: Pacientes com trauma craniano leve, entre 0 e 19 anos, admitidos em um centro de referência em traumatologia, na cidade do Salvador, Brasil, entre maio 2007 e maio 2008. Resultados: Foram atendidos 1888 pacientes com trauma craniano leve, com idade média de 7,4 (±5,5) anos. Um total de 1956 radiografias simples e 734 TCC foram realizadas. Em 44,4% dos pacientes com escala de coma de Glasgow (GCS) 13 e 55.4% com GCS 14, tiveram TCC com achados anormais. Em pacientes com múltiplos traumas, 16% possuíam alterações na TCC. Conclusão: Recomendamos TCC em pacientes com GCS 13 e 14 ou naqueles com traumas múltiplos, independente do GCS. Radiografias simples do crânio como rotina, não foram identificadas como úteis, no presente estudo.

Do children with Glasgow 13/14 could be identified as mild traumatic brain injury?

“…We agree with previous authors with regard to the need of performing CT scans in multiple trauma victims and in those with GCS score of 13 or 14 14,15,18,25,26 who have had more severe mechanisms of injury. Nevertheless, we must keep in mind that some children with GCS 15 must be submitted to CT scans as well, regarding some neurological findings 14,15,18,[25][26][27] .…”

“…Nevertheless, we must keep in mind that some children with GCS 15 must be submitted to CT scans as well, regarding some neurological findings 14,15,18,[25][26][27] . We observed here different modalities of treatment among children and adolescents with MTBI in confluence to previous studies [14][15][16]25 .…”

Scandinavian guidelines for initial management of minor and moderate head trauma in children

“…The initial recommendation draft included “altered mental status”, defined according to Kupperman et al as a predictor [ 7 ]. Since irritability, somnolence and confusion are all included in the definition of a GCS score lower than 15, the “altered mental status” was changed to “GCS score 14” after the first Delphi round [ 7 , 22 , 51 , 53 , 55 – 58 , 62 – 65 , 67 , 68 , 75 , 77 – 82 ].…”