Is Routine Repeated Head CT Necessary for All Pediatric Traumatic Brain Injury?

Abstract

ObjectiveRepeated computed tomography (CT) follow up for traumatic brain injury (TBI) patients is often performed. But there is debate the indication for repeated CT scans, especially in pediatric patients. Purpose of our study is to find risk factors of progression on repeated CT and delayed surgical intervention based on the repeated head CT.MethodsBetween March, 2007 and December, 2013, 269 pediatric patients (age 0-18 years) had admitted to our hospital for head trauma. Patients were classified into 8 subgroups according to mechanisms of injury. Types, amount of hemorrhage and amount changes on repeated CT were analyzed as well as initial Glasgow Coma Scale (GCS) scores.ResultsWithin our cohort of 269 patients, 174 patients received repeat CT. There were progression in the amount of hemorrhage in 48 (27.6%) patients. Among various hemorrhage types, epidural hemorrhage (EDH) more than 10 cc measured in initial CT was found to be at risk of delayed surgical intervention significantly after routine repeated CT with or without neurological deterioration than other types of hemorrhage. Based on initial GCS, severe head trauma group (GCS 3-8) was at risk of delayed surgical intervention after routine repeated CT without change of clinical neurologic status.ConclusionWe suggest that the patients with EDH more than 10 cc or GCS below 9 should receive repeated head CT even though absence of significant clinical deterioration.

The Necessity of Follow-Up Brain Computed-Tomography Scans: Is It the Pathology Itself Or Our Fear that We Should Overcome?

“…When the causes are categorised according to age subgroups: falls are common in infants, whereas road accidents are more common in older children, respectively [ 1 ]. Male predominance in pediatric age head traumas was reported in multiple series as same as the present study (males-53%, p = 0.002) [ 1 , 9 , 13 - 16 ]. This finding could be explained by the risk-taking behaviour of boys [ 1 ].…”

“…What the rate of follow-up CT scans in our study was 11.8%, which is far behind the rates of similar studies (24-65%) [ 9 , 24 ]. Repeat CT scan resulted in late surgical intervention in only one patient (1%), which is comparable to other similar studies (1-24%) [ 8 , 9 , 11 , 25 , 26 , 28 ]. Kim et al, found only the epidural hematoma other than another kind of intracranial pathologies being a predictor of late surgical intervention.…”

“…Fall is the most common mechanism of brain injury, and road accident is the second one in the pediatric age group [ 9 ]. When the causes are categorised according to age subgroups: falls are common in infants, whereas road accidents are more common in older children, respectively [ 1 ].…”

“…It has been shown that thyroid malignancy is seen in 4-65/1.000.000 CT scans in children [ 22 , 23 ]. Not only the radiation itself but also the need for sedation in uncooperative and lethargic pediatric patients yields additional risks [ 9 ]. Contrarily, there is a debate on if some deteriorating cases might be missed by denying repeat CT scan [ 24 - 26 ].…”

Incidence of progressive hemorrhagic injury in patients presenting with traumatic brain injury at a large tertiary care hospital in Karachi, Pakistan. A Case Series.

“…It is also known as progressive hemorrhagic injury. 5,6,7,8,9,10 CT scan modality is used for quick assessment of acute head trauma and informs management of the patients. It informs the surgeon if the patient required decompressive surgery or conservative monitoring.…”