Role of routine repeat head imaging in paediatric traumatic brain injury

Lim

et al. 2015

J Korean Neurosurg Soc

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.

Section: Discussionsupporting

confidence: 55%

Section: Discussionmentioning

confidence: 99%

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

Lim

et al. 2015

J Korean Neurosurg Soc

“…The pediatric studies on this topic widely differ for the characteristics of the population included, the severity of the head injury and the final outcome [ 113 – 122 ]. Children with moderate or severe head injury are more likely to undergo a change in management following results of repeated CT scan [ 119 ].…”

Section: Diagnosis Of Clinically Important Traumatic Brain Injurymentioning

confidence: 99%

“…Conversely, all the three patients who underwent repeated CT because of clinical deterioration showed injury progression and two of them needed neurosurgery [ 119 ]. Another study of patients 0–18 years of age, including a subgroup with a GCS of 13–15, reported no need of management variation in all the patients with minor head trauma who underwent routine repeated CT scans [ 122 ]. A study of 120 patients aged 1 week to 17 years with GCS 14–15 following head trauma found a progression of injury on routine repeated CT in 7 (6.6%) patients, with two patients requiring neurosurgery for an epidural hematoma.…”

Section: Diagnosis Of Clinically Important Traumatic Brain Injurymentioning

confidence: 99%

Italian guidelines on the assessment and management of pediatric head injury in the emergency department

et al. 2018

ObjectiveWe aim to formulate evidence-based recommendations to assist physicians decision-making in the assessment and management of children younger than 16 years presenting to the emergency department (ED) following a blunt head trauma with no suspicion of non-accidental injury.MethodsThese guidelines were commissioned by the Italian Society of Pediatric Emergency Medicine and include a systematic review and analysis of the literature published since 2005. Physicians with expertise and experience in the fields of pediatrics, pediatric emergency medicine, pediatric intensive care, neurosurgery and neuroradiology, as well as an experienced pediatric nurse and a parent representative were the components of the guidelines working group.Areas of direct interest included 1) initial assessment and stabilization in the ED, 2) diagnosis of clinically important traumatic brain injury in the ED, 3) management and disposition in the ED. The guidelines do not provide specific guidance on the identification and management of possible associated cervical spine injuries. Other exclusions are noted in the full text.ConclusionsRecommendations to guide physicians practice when assessing children presenting to the ED following blunt head trauma are reported in both summary and extensive format in the guideline document.

Trends and variation in repeat neuroimaging for children with traumatic intracranial hemorrhage

et al. 2021

Objectives We aimed to determine trends and institutional variation in repeat neuroimaging in children with traumatic intracranial hemorrhage and to identify factors associated with neuroimaging modality (subsequent magnetic resonance imaging [MRI] vs computed tomography [CT]). Methods We conducted a retrospective cross‐sectional study of 35 hospitals in the Pediatric Health Information System database. We included children <18 years of age hospitalized from 2010–2019 with intracranial hemorrhage and who underwent a brain CT. We calculated repeat neuroimaging rates by modality and used regression analyses to examine temporal trends. We used hierarchical logistic regression to identify factors associated with subsequent MRI versus repeat CT, controlling for hospital. Results We identified 12,714 children with intracranial hemorrhage, of which 5072 with repeat neuroimaging were studied. Of the 5072 children with repeat neuroimaging, repeat CT was performed in 67.6% (n = 3429) and subsequent MRI in 32.4% (n = 1643). Overall repeat neuroimaging with either a CT or MRI remained similar from 2010–2019 ( P = 0.431); however, repeat CT scans significantly decreased ( P = 0.001); whereas, MRIs significantly increased ( P < 0.001). Repeat neuroimaging by hospital ranged from 20%–80%. After controlling for institution, subsequent MRI was more likely to be used in younger children and children who did not receive hyperosmotic agents, neurosurgical interventions, or intensive care unit admission (all P ‐values <0.001). Conclusions We found that repeat neuroimaging rates for children with intracranial hemorrhage vary substantially by institution. We also found that although MRI was increasingly used to re‐image these children, overall repeat neuroimaging rates (CT or MRI) have not decreased over the past decade. Future work to implement optimal utilization of neuroimaging in these children is needed.