Head injury: which patients need imaging? Which test is best?

Glauser, Jonathan

doi:10.3949/ccjm.71.4.353

Cited by 26 publications

(18 citation statements)

References 37 publications

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“…Complications of mild head trauma are unusual, but in rare cases it can be life-threatening and require neurosurgical intervention (0.4%-1.0%). Cranial computed tomography (CCT) scan is the imaging study of choice, although some considerations about cost, medical staff, patient sedation and proper devices limit its routine use in children and adolescents [7][8][9][10][11] . There are some divergences regarding CCT scan and skull radiograph indications in pediatric population 4,6,7,10,11 .…”

mentioning

confidence: 99%

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

Melo

Reis²,

Lemos-Júnior³

et al. 2008

Arq. Neuro-Psiquiatr.

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-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.

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mentioning

confidence: 99%

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

Melo

Reis²,

Lemos-Júnior³

et al. 2008

Arq. Neuro-Psiquiatr.

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“…In acute settings imaging helps in accurate localization of any cerebral damage. During first 24 hours of injury conventional CT scan is considered to be imaging modality of choice because of its availability, lesser imaging time, able to perform on disturbed patients and cost effective (2). CT scan is superior in detecting any bony damage and bleeding in brain parenchymal or meninges or spaces (3).…”

Section: Location Of Abnormal Ct Signsmentioning

confidence: 99%

“…CT characteristics not only widely accepted for descriptive purposes, but also increasingly being used as major predictor of outcome in TBI. Following TBI the pathological findings on CT scan that is represented by scoring system is oriented in predicting prognification of outcome (2,4,12,13). Various studies and the international guidelines on prognosis include the CT scoring system as a major outcome predictor13.…”

Section: Introductionmentioning

confidence: 99%

Commonly available CT characteristics and prediction of outcome in traumatic brain injury patients

Kumar¹,

Reddy²,

Pratyusha³

et al. 2017

Romanian Neurosurgery

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Abstract:Background: Acute Computerized Tomography (CT) characteristics are used widely and most accepted for prediction of outcome among Traumatic Brain Injury (TBI). The commonly available and simple combinations of existing and unexplored CT parameters may be more useful in prediction of outcome. The present study explores commonly available CT characteristics by possible combinations based on anatomical basics. Methods: Abnormal CT sign was considered with any cranial lesion. Based on anatomical locations of cortical lobes, nine possibilities were made that include individual and combinations of mentioned lobes. The laterality was either right or left or bilateral. The outcome was favourable or unfavourable based on discharge Glasgow Outcome Scale (GOS). Binary logistic regression was used to predict outcome.Brought to you by | MIT Libraries Authenticated Download Date | 5/13/18 4:07 AM | Kumar et al -Commonly available CT characteristicsResults: 452 patients were recruited in the present study. There was significant risk of unfavourable outcome among patients with location of Sub Dural Haemorrhage (SDH) in Parietal + Temporal region (OR=10,p<0.001); Cerebral Contusion in Temporal region (OR=3,p=0.03), Frontal + Temporal region(OR=16,P=0.001), Frontal + Parietal + Temporal region (OR=18.7,p<0.001). Patients with four abnormal CT signs had worst outcome. Presence of SDH on right side (OR=4.5,p<0.001) and bilateral Cerebral Contusion (OR=4.5,p=0.003) was at the risk of unfavourable outcome. Conclusion: The present study based on anatomical classification has shown that location and laterality of lesion can significantly predict TBI outcome.

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“…According to our findings, head injury was commonly associated to the use of CT and remained essentially stable during the study period. Cranial CT scanning is considered to be the imaging modality of choice for the rapid and reliable diagnosis of traumatic head injuries (9). Several retrospective studies conclude that CT is indicated in all patients with minor head injury (10)(11).…”

Section: Indicationmentioning

confidence: 99%

Demographic changes in brain CT and MRI between 1990 and 2010

Vancauwenberghe¹,

Demaerel²

2013

Journal of the Belgian Society of Radiology

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Study objective: During the last decades, computed tomography and magnetic resonance imaging have revolutionized neuro-imaging. Nowadays these techniques are routinely used, but the extent and variation of use has been investigated poorly. Our purposes were to retrospectively determine the evolution in demographic variables and indications of cranial CT and MRI scanning in 1993, 2000 and 2009, at our hospital. Methods: We retrospectively studied medical and neurologic in-and outpatients, who underwent CT-or MR imaging of the head for several demographic and patient characteristics. Results: We observed a modest increase in mean age and a marked increase in total number of cranial CT examinations, MR confirmation studies and repeat examinations. Metastatic disease, head injury and headache were indications associated with more rapid growth in CT use than were others. Conclusion: Among the 5 patient and hospital factors considered (total number of examinations, age, indication, MR confirmation study and repeat examinations), all had a significant variation during the past 16 years. Strict regulations with compelling guidelines for the rational use of brain CT and MRI are inevitable in order to control expenditure and radiation exposure.

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Head injury: which patients need imaging? Which test is best?

Abstract: Some patients with head injuries definitely need to undergo an imaging study-usually computed tomography (CT). Most, however, are in a category of "apparently mild" injury, and controversy continues about which of them need to undergo imaging studies to rule out intracranial injuries.

Cited by 26 publications

References 37 publications

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

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

Commonly available CT characteristics and prediction of outcome in traumatic brain injury patients

Demographic changes in brain CT and MRI between 1990 and 2010

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