Repeat computed tomographic scan within 24-48 hours of admission in children with moderate and severe head trauma

Tabori, Uri; Kornecki, Alik; Sofer, Shaul; Constantini, Shlomo; Paret, Gideon; Beck, Raphael; Sivan, Yakov

doi:10.1097/00003246-200003000-00038

Cited by 74 publications

(77 citation statements)

References 16 publications

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“…In pediatric guidelines and retrospective pediatric studies of all traumatic brain injuries, repeat imaging is recommended for some observed patients given concern for progression of injury [8,16,24,25,26,27]. While repeat imaging was common in our study population, the initial repeat CT image showed an increase in hematoma size in a minority of patients and led to surgery in only 1 patient.…”

Section: Discussionmentioning

confidence: 92%

“…While repeat imaging was common in our study population, the initial repeat CT image showed an increase in hematoma size in a minority of patients and led to surgery in only 1 patient. Two smaller studies by Durham et al [24] and Tabori et al [27 ]noted that management was affected by an initial repeat CT in only a small minority of patients.…”

Section: Discussionmentioning

confidence: 99%

“…Tabori et al [27] and Hollingworth et al [28 ] each noted 1 EDH patient with changed management after a second repeat scan, but these patients also had clinical deterioration. These observations highlight the need for a better understanding of the utility of multiple repeat CT scans in clinically stable EDH patients so that CT imaging may be optimally used to direct treatment while minimizing radiation exposure and its associated risks [29,30].…”

Section: Discussionmentioning

confidence: 99%

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Utility of Clinical and Radiographic Findings in the Management of Traumatic Epidural Hematoma

Flaherty¹,

Loya²,

Alexander³

et al. 2013

Pediatr Neurosurg

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Background: There are currently no clear guidelines for the management and radiological monitoring of pediatric patients with epidural hematomas (EDH). We aim to compare clinical and radiographic characteristics of pediatric EDH patients managed with observation alone versus surgical evacuation and to describe results of repeat head imaging in both groups. Methods: We performed a retrospective observational study of pediatric patients diagnosed with traumatic EDH at a level II trauma center. Results: Forty-seven cases of EDH were analyzed. Sixty-two percent were managed by observation alone. Patients undergoing surgery were more likely to have an altered mental status (17 vs. 72%, p < 0.001), but there were no other significant clinical differences between the groups. The mean initial EDH thickness and volume were 8.0 mm and 8.6 ml in the observed group and 15.5 mm and 35 ml in the surgery group, respectively (p < 0.001 for both comparisons). Eighty-six percent of the observed and all surgery patients underwent repeat CT imaging. The initial repeat CT scan results led to surgery in 1 patient who was initially treated with observation. Conclusions: Most pediatric patients with EDH can be managed with observation. Mental status and radiographic findings should guide the need for surgical intervention. Multiple repeat CT scans have minimal utility in changing management.

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Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Utility of Clinical and Radiographic Findings in the Management of Traumatic Epidural Hematoma

Flaherty¹,

Loya²,

Alexander³

et al. 2013

Pediatr Neurosurg

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“…Intracranial pressure (ICP) monitoring plays a valuable role in the management of children with head injuries as well as atraumatic conditions associated with intracranial hypertension [1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14]. Overall, insertion of an ICP monitor is felt to be a safe and effective adjunct in the management of raised ICP, with a low incidence of hemorrhagic or infectious complications [15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27].…”

Section: Introductionmentioning

confidence: 99%

Hemorrhagic Complications of Intracranial Pressure Monitors in Children

Bláha

Lazar²,

Winn³

et al. 2003

Pediatr Neurosurg

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Intracranial pressure (ICP) monitoring plays a valuable role in the management of head injuries and other causes of raised ICP in the pediatric population. The purpose of this study was to investigate the incidence of hemorrhage after ICP monitor insertion, and to classify these complications in a clinically relevant manner. Hospital charts of 431 children (ages 0–16 years) admitted to a level I trauma center over a 2-year period were reviewed and 112 patients (134 insertions) who underwent intraparenchymal ICP monitoring were identified. The authors reviewed postoperative neuroradiological studies. One hundred and nineteen procedures were carried out without any hemorrhage (grade 0). After 10 insertions, a small punctate hemorrhage or localized subarachnoid hemorrhage occurred (grade 1). Three patients sustained an intracerebral hemorrhage that did not require evacuation or manifest as a new neurological deficit (grade 2). There were no hemorrhagic complications that necessitated evacuation or resulted in a noticeable change in the patient’s clinical condition (grade 3). We propose a new grading system for hemorrhage after ICP monitor insertion. We found a complication rate close to 10% in our pediatric patients. Fortunately, these hemorrhages were clinically silent and no neurosurgical intervention was necessary. However, grade 1 and grade 2 hemorrhages may manifest with a false reading of high ICP, and the long-term consequences of these complications are not known. Of note, only 23% of these complications were reflected in the patients charts, which may explain the low complication rates reported in other studies that did not analyze postoperative neuroradiological studies.

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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: 99%

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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Repeat computed tomographic scan within 24-48 hours of admission in children with moderate and severe head trauma

Cited by 74 publications

References 16 publications

Utility of Clinical and Radiographic Findings in the Management of Traumatic Epidural Hematoma

Utility of Clinical and Radiographic Findings in the Management of Traumatic Epidural Hematoma

Hemorrhagic Complications of Intracranial Pressure Monitors in Children

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

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