Clinical manifestations that predict abnormal brain computed tomography (CT) in children with minor head injury

Abstract

Background:Computed tomography (CT) used in pediatric pediatrics brain injury (TBI) to ascertain neurological manifestations. Nevertheless, this practice is associated with adverse effects. Reports in the literature suggest incidents of morbidity and mortality in children due to exposure to radiation. Hence, it is found imperative to search for a reliable alternative.Objectives:The aim of this study is to find a reliable clinical alternative to detect an intracranial injury without resorting to the CT.Materials and Methods:Retrospective cross-sectional study was undertaken in patients (1-14 years) with blunt head injury and having a Glasgow Coma Scale (GCS) of 13-15 who had CT performed on them. Using statistical analysis, the correlation between clinical examination and positive CT manifestation is analyzed for different age-groups and various mechanisms of injury.Results:No statistically significant association between parameteres such as Loss of Consciousness, ‘fall’ as mechanism of injury, motor vehicle accidents (MVA), more than two discrete episodes of vomiting and the CT finding of intracranial injury could be noted. Analyzed data have led to believe that GCS of 13 at presentation is the only important clinical predictor of intracranial injury.Conclusion:Retrospective data, small sample size and limited number of factors for assessing clinical manifestation might present constraints on the predictive rule that was derived from this review. Such limitations notwithstanding, the decision to determine which patients should undergo neuroimaging is encouraged to be based on clinical judgments. Further analysis with higher sample sizes may be required to authenticate and validate findings.

Dilemma in Pediatric Head Trauma: Is Cranial Computed Tomography Necessary or Not in Minor Head Traumas?

“…13 18 Alharthy ve ark. 19 iki yüz seksen dokuz hafif kafa travmalı çocukta çekilen BBT'lerin %5'inden azında patolojik bulgu saptandığını ve hiçbir çocukta cerrahi girişim gerekmediğini bildirmişlerdir. Bu çalışmada 1,5 metreden daha yüksekten düşme veya 5 basamaktan fazla yükseklikten düşme hafif kafa travmalı çocuklarda intrakranyal yaralanma için güçlü belirleyici olarak bulunmuştur.…”

“…Aynı zamanda kusmanın intrakranyal yaralanması olan çocuklarda daha çok görüldüğü ancak bunun istatistiksel olarak anlamlı olmadığı bildirilmiştir. 19 Bizim çalışmamızda ise literatürden farklı olarak kusma, bilinç kaybı, konvülsiyon ya da kafada kesi olmasıyla BBT'de anormal bulgu saptanması arasında anlamlı ilişki saptanmadığı gibi travmanın oluş şekli ile BBT'de anormal bulgu saptanması arasında da anlamlı ilişki saptanmadı.…”

A Experiência duma Norma de Atuação no Traumatismo Crânio-Encefálico Ligeiro em Idade Pediátrica: Estudo Longitudinal de Três Anos

“…19 Estudos recentes demonstram que a presença de sonolência, vómitos ou cefaleias não se associa a uma maior probabilidade de LIC clinicamente significativa, sobretudo quando estes sintomas são transitórios e autolimitados. 3,13,17,30,33,34 Em Portugal, a literatura neste âmbito é ainda escassa. Desde 2004 vigora na nossa instituição uma norma de atuação nos TCE ligeiros que prevê o internamento e vigilância em meio hospitalar dos TCE ligeiros com determinados sinais de alarme na avaliação inicial, em alternativa à TC-CE imediata (Tabela 1).…”

Retroclival Pneumocephalus Associated with Bilateral Abducens Palsy in a Child

“…Children who have suffered TBI usually present with minor symptoms which do not require neurosurgical interventions [1]. Posterior fossa lesions are even more uncommon, but, when present, are usually described as epidural hematomas [2].…”

“…Traumatic brain injury (TBI) is not as common in children as in adults [1]. Children who have suffered TBI usually present with minor symptoms which do not require neurosurgical interventions [1].…”