Severe head trauma in children: cranial computer tomography and clinical consequences
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Wolfgang Hirsch1, Axel Schobess, Gerburg Eichler
1Department of Diagnostic Radiology/Paediatric Radiology, Martin-Luther-University Halle-Wittenberg, Germany. w.hirsch@t-online.de
Insights
Cranial computerized tomography (CCT) in children with severe head trauma helps guide surgical treatment. However, initial CCT findings alone do not always predict outcomes or dictate care in the pediatric intensive care unit.
Area of Science:
- Pediatric Neurology
- Neuroradiology
- Trauma Care
Background:
- Severe head trauma in children necessitates careful monitoring and prognostic evaluation.
- Cranial computerized tomography (CCT) is a key diagnostic tool in assessing head injuries.
- Understanding the implications of CCT findings is crucial for effective management.
Purpose of the Study:
- To investigate the prognostic and therapeutic significance of CCT examinations in pediatric severe head trauma.
- To correlate initial CCT findings with neurological outcomes at 1 month and 1 year post-trauma.
- To assess the impact of CCT on treatment decisions in the pediatric intensive care unit.
Main Methods:
- Retrospective analysis of CCT scans from 248 children (0.1-14 years) with severe head trauma.
- Documentation of initial CCT findings, examination frequency, and treatment duration.
- Assessment of neurological outcomes at 1 month and 1 year post-injury.
Main Results:
- 29% of children had no CCT changes; 40.3% had single findings; 30.6% had combined injuries.
- No consciousness impairment was observed in children with normal CCT or isolated hemorrhages.
- Massive brain edema, parenchymal/ventricular bleeding, and focal edema were associated with poor prognosis and neurological deficits.
- An average of 3.0 CCT scans per child were performed, with significant individual variation.
Conclusions:
- Initial CCT findings are important for surgical treatment decisions in pediatric severe head trauma.
- CCT results had limited direct impact on treatment protocols in the pediatric intensive care unit for non-surgical cases.
- Prognosis can be poor even with minimal CCT changes like focal edema or isolated ventricular bleeding, highlighting the need for comprehensive assessment.
Background:
We investigated the prognostic and therapeutic implications of cranial computerized tomography (CCT) examinations after severe head trauma in children.
Materials And Methods:
The CCT scans from 248 children (aged 0.1-14 years) during the course of treatment after severe head trauma were assessed. The initial CCT findings, the frequency of CCT examinations and the schedule as well as duration of treatment were registered. The neurological outcome was examined both 1 month and 1 year after the trauma.
Results:
Approximately one-third (29%) of the children who suffered from severe head trauma showed no changes in the CCT. Furthermore, 40.3% of the children showed a singular finding in the CCT, whereas 30.6% of all children had a combined injury pattern. One year after trauma, we found no impairment of consciousness in children without pathological CCT findings, as well as in cases with isolated epidural and subdural haemorrhage. Children with massive generalized brain oedema had the poorest prognosis (37% died, 25% had impairment of consciousness). The outcome of children with parenchymal and ventricular bleeding was also unfavourable (23.1% and 33.3% neurological findings). Patients with focal oedema likewise had impairment of consciousness. An average number of 3.0 CCT per child was performed but numbers in single cases varied greatly (1-13 scans per individual).
Conclusions:
The initial CCT was of importance regarding further therapy, especially for children in need of surgical treatment. In the other cases, there was no direct impact from CCT findings on treatment procedures in the paediatric intensive care unit. The initial CCT was related to the prognosis, which can be poor even if there are only minimal changes in CCT, such as focal oedema or isolated ventricular bleeding.
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