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Repeat computed tomographic scan within 24-48 hours of admission in children with moderate and severe head trauma
U Tabori1, A Kornecki, S Sofer
1Pediatric Intensive Care Unit, Dana Children's Hospital Tel Aviv Medical Center, Israel.
Insights
A routine repeat head CT scan in pediatric patients with moderate to severe head trauma rarely changes treatment. Clinically guided scans may better identify patients needing intervention, including surgery.
Area of Science:
- Pediatric neurosurgery
- Neuroradiology
- Trauma care
Background:
- Moderate to severe head trauma in children requires careful monitoring.
- Repeat head computed tomographic (CT) scans are often used to assess changes.
- The utility of routine, predetermined repeat head CT scans in pediatric head trauma is debated.
Purpose of the Study:
- To evaluate the diagnostic yield and clinical impact of a routine repeat head CT scan performed 24-36 hours after initial imaging in pediatric patients with moderate to severe head trauma.
- To determine if these routine scans lead to changes in patient management or surgical intervention.
Main Methods:
- Retrospective chart review of 173 pediatric patients admitted to five Israeli trauma centers with moderate to severe head trauma (Glasgow Coma Scale score ≤ 11).
- Data collected included clinical status, CT scan findings (first, second, and third if performed), and treatment strategies.
- Analysis focused on new lesions identified on the second CT scan and their impact on therapy.
Main Results:
- Of 173 patients, 47 (27%) had new lesions on their second head CT scan, including intracranial hemorrhages, worsening brain edema, and contusions.
- None of the findings from the second CT scan necessitated surgical intervention or a change in overall therapy.
- A third CT scan was performed in 67 patients, with two cases requiring surgery due to new findings.
Conclusions:
- Routine, predetermined repeat head CT scans within 24-36 hours are unlikely to alter therapy in pediatric patients with moderate to severe head trauma.
- Clinically indicated or intracranial pressure-monitored CT scans may be more effective in identifying patients requiring therapeutic changes, including surgery.
- Further research is needed to establish optimal timing and indications for repeat head CT scans in this population.
Objective:
To asses the yield and contribution of a routine predetermined repeat head computed tomographic (CT) scan within 24-36 hrs in pediatric patients with moderate to severe head trauma.
Design:
Records review.
Setting:
Five pediatric intensive care units.
Patients:
We reviewed the charts of 173 consecutive pediatric patients with moderate to severe head trauma (Glasgow Coma Scale score of < or = 11) that survived the first 24 hrs after being admitted to five Israeli trauma centers. Clinical data collected included status at admission, at the time between the first and second CT scans, and after the second scan. Head details of the first, second, and, if performed, third CT scan were collected. Treatment strategy during each period was recorded, including any change in treatment after each CT scan.
Measurements And Main Results:
A total of 47 (27%) of the second CT scans showed new lesions including six intracranial hemorrhages, 17 cases of worsening brain edema, and 18 newly diagnosed brain contusions. However, none of these findings necessitated surgical intervention or any change in therapy. Of the 67 patients who underwent a third CT scan, two cases required surgical intervention because of new findings in the third CT.
Conclusions:
A second routine prescheduled head CT scan within 24-36 hrs after admission in pediatric patients with moderate to severe head trauma is unlikely to yield any change in therapy. Clinically and intracranial pressure-oriented CT scan may better select and diagnose patients who require changes in therapy, including surgery. Studies aimed to determine the ideal timing for the second are warranted.