Clinical efficacy of serial computed tomographic scanning in pediatric severe traumatic brain injury

Figg, Ryan; Stouffer, Chadwick W.; Kolk, Wayne E. Vander; Connors, Robert H.

doi:10.1007/s00383-005-1560-0

Cited by 36 publications

(37 citation statements)

References 20 publications

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“…However, case reports of delayed traumatic epidural and subdural hematoma after an initial lucid period (9,10) have led some to consider routinely repeating CT even in the absence of any clinical signs of deterioration (3,4,11). In theory, routinely repeated head CTs could identify new or worsening TBI before permanent neurologic damage occurs, thereby enabling early intervention and improvement in outcomes.…”

mentioning

confidence: 94%

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The use of repeated head computed tomography in blunt pediatric head trauma: Factors predicting new and worsening brain injury*

Hollingworth

Vavilala

Jarvik

et al. 2007

Pediatric Critical Care Medicine

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Repeat head computed tomography imaging is frequently used. About 30% of repeated computed tomographies showed new or worsening brain injury. However, worsening brain injury on repeat computed tomography rarely resulted in neurosurgical intervention. Patients with moderate or severe head injury and intraparenchymal injuries were more likely to show worsening brain injury and undergo neurosurgical intervention.

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mentioning

confidence: 94%

“…There is little information about the diagnostic and therapeutic impact of repeated head CT for pediatric blunt head injury, and opinion is divided on the value of routinely repeating imaging at a prescheduled interval postinjury (4,6,11).…”

mentioning

confidence: 99%

The use of repeated head computed tomography in blunt pediatric head trauma: Factors predicting new and worsening brain injury*

Hollingworth

Vavilala

Jarvik

et al. 2007

Pediatric Critical Care Medicine

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“…However, increased awareness of the risks of HCT and the lack of evidence supporting its use suggest that routine follow-up HCT may not be justified in this patient population. In fact, numerous studies do not support routine repeat HCT without changes in clinical exam or neurological deterioration [5,6,7,8,9,10,11,12,13,14,15]. However, most of these studies were conducted in adults; it is unclear if these findings can be extrapolated to children.…”

Section: Discussionmentioning

confidence: 89%

Is Repeat Head Computed Tomography Necessary in Children Admitted with Mild Head Injury and Normal Neurological Exam?

et al. 2012

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Background: Children admitted following mild head injury (MHI) often undergo repeat head computed tomography (HCT) to identify progression of injury, although there is little evidence to support this practice. Methods: From January 2007 to December 2009, we retrospectively reviewed the medical records of patients aged 2 months to 18 years admitted with a diagnosis of MHI to a Level I Pediatric Trauma Center. Data including Glasgow Coma Scale, loss of consciousness, length of stay (LOS), and number and results of HCTs were analyzed. Results: A total of 507 patients were admitted with MHI and normal neurological exam; 389 had a normal and 118 had an abnormal initial HCT. The median LOS in the normal HCT group was 17.68 h (5.47-109.68) and in the abnormal HCT group 36.63 h (10.15-192.40). The median number of HCTs in the normal HCT group was 1 (1-2) and in the abnormal HCT group 2 (1-5). Conclusions: Children admitted with MHI, abnormal initial HCT and normal neurological exam had longer LOS and more HCTs compared with children with normal initial HCTs. No patient in either group had any change in their management based on HCT. Therefore, repeat HCT may be unnecessary for patients with MHI and normal neurological exam.

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“…In a study by Isik et al (25), 89.2% of patients were shown total recovery, 7% was discharged by sequelae and the mortality rate was reported as 3.8%. Figg et al reported that the emergent operations were applied to the patients with serious TBI in repeated CT screening and only with increased intracranial pressure (21%) and deterioration in neurological findings (3%) (26). They also reported that emergent operation application is not necessary for the patients who had CT screening without any routine findings.…”

Section: Discussionmentioning

confidence: 99%

Travmatik Beyin Hasarlı Çocuk Hastalarda Tekrarlayan Bilgisayarlı Tomografinin Değerliliği ve Radyasyon Hasarı

Yazıcıoğlu

Özüçelik

Ayvaci

et al. 2014

HSP

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25'i (%32,9) kız ve yaş ortalamaları 5,82 ± 3,66 bulundu. Araştırmaya alınan 76 hastaya toplamda 317 kez BT çekilmişti. Hastaların %42,10'una üç BT çekilirken geri kalanına üçten fazla BT çekilmişti. Hastaların %78,94'ünün sekelsiz taburcu olduğu, %7,9'unun opere edildiği görüldü. Hastaların ikinci BT'lerinde birinci BT'lerine göre sadece 2 hastada değişiklik saptandığı, yeni gelişen lezyon olarak bir hastada epidural hematom ve bir hastada subdural hematomun ortaya çıktığı belirlendi. Birinci BT sonuçlarına göre hastaların %7.9'una cerrahi tedavi uyulandı. Hastaların %92.1'i herhangi bir cerrahi tedavi uygulanmadan hastaneden taburcu oldu. Hastaların %6.6'sı sekelli iyileşirken, mortalite oranı %1.3 olarak bulundu. Tekrarlayan BT'ler ile çocuklara ek radyasyon dozu verilirken, tedavilerinde herhangi bir değişiklik oluşmadı. Sonuç: Kafa travmalı çocuklarda tekrarlayan BT'lerin hastanın prognozuna, acil cerrahi girişim ve tahmini yaşam beklentisine bir katkısı olmadığı tespit edilmiştir. Tekrarlayan BT çekimi uygulanan çocuklar, gelecekte radyasyon ile ilişkili gelişebilecek hastalıklar yönünden izlenmelidir. -diagnosis. Forty two point one percent of patients had CT three times, the rest had more than three times; total CT number was 317. Two patients showed changes in second CT (one epidural and one subdural hemorrhage) according to first CT whereas there was no change in third CT. The decision of operation in all operated patients treated surgically (7.9%) was given according to the result of first CT. While 92.1% of patients were discharged from the hospital by complete recovery, 6.6% of patients were with sequelae and mortality ratio was 1.3%. The changes in repeated CT did not change the treatment while every child was exposed to additional radiation. Conclusion: Repeated CT in children with head trauma did not contribute to the prognosis of patients, the choice of treatment and survival. The children applied serial CT should be followed for the diseases which can be progressed due to radiation in future.Key words: Head trauma in children, repeated brain CT, radiation exposure, traumatic brain injury Introduction Traumatic Brain Injury (TBI) is one of the most important diseases of 21. century which causes mortality and disablement (1,2). Different procedures about the indication, dosage of Head CT and repeated CT used common in pediatric TBI have been performed in different centers (3-4).The rates of CT used in the USA and other countries have increased rapidly particularly in the past 10 years (5). The use of CT procedures has expanded to more than 70 million in the United States per year, with nearly 10% of procedures performed on children (6).Although CT scans are very useful clinically, recent reports have raised concerns about the potential for malignancy following CT scanning, especially in pediatric patients (5) In a case-control study (part of the UK Childhood Cancer Study) by Rajaraman et al. was showed further evidence of possible excess risk of cancer, even at doses lower than those associated...

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Clinical efficacy of serial computed tomographic scanning in pediatric severe traumatic brain injury

Cited by 36 publications

References 20 publications

The use of repeated head computed tomography in blunt pediatric head trauma: Factors predicting new and worsening brain injury*

The use of repeated head computed tomography in blunt pediatric head trauma: Factors predicting new and worsening brain injury*

Is Repeat Head Computed Tomography Necessary in Children Admitted with Mild Head Injury and Normal Neurological Exam?

Travmatik Beyin Hasarlı Çocuk Hastalarda Tekrarlayan Bilgisayarlı Tomografinin Değerliliği ve Radyasyon Hasarı

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