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

The purpose of this study is to determine whether serial computed tomography (CT) scans of the head lead to operative intervention in pediatric patients with severe traumatic brain injury (TBI). Serial CT scans are those done in addition to the initial CT scan and one follow up CT scan in the first 24-48 h. This study is a retrospective review from January 1990 to December 2003. The hospital course was reviewed for 942 pediatric patients with traumatic brain injuries. Of these, 40 patients were identified who met the following criteria: age less than 18, admission, Glasgow Coma Scale (GCS) < or = 8, intra-cranial pressure (ICP) monitoring during hospitalization, no craniotomy at admission, and at least one serial CT scan after the first 48 h. One hundred fifteen serial CT scans were ordered. Eighty-seven were ordered for routine follow up, 24 were ordered for increased ICP, and 4 were ordered for neurologic change. One craniotomy and one burr hole were performed based on serial CT scans ordered for increased ICP. Serial CT scans, beyond the initial and follow-up scans, have a limited role in children with severe TBI. In this series, only serial CT scans ordered for increased ICP (21%) and neurologic deterioration (3%) led to operative interventions. Serial scans ordered for routine follow-up (76%) resulted in no operative interventions.