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Value of repeat cranial computed tomography in pediatric patients sustaining moderate to severe traumatic brain
Paulo Sérgio Lucas da Silva1, Maria Eunice Reis, Vânia Euzébio Aguiar
1Pediatric Intensive Care Unit, Department of Pediatrics, Hospital do Servidor Público Municipal, São Paulo, Brazil. psls.nat@terra.com.br
Insights
Repeat head CT scans in children with moderate to severe traumatic brain injury (TBI) may not be necessary if neurological exams show improvement. Clinical monitoring can guide decisions on neurosurgical intervention, potentially avoiding unnecessary imaging.
Area of Science:
- Pediatric neurosurgery
- Neuroradiology
- Critical care medicine
Background:
- Repeat head computed tomography (CT) is common for traumatic brain injury (TBI).
- The utility of repeat CT scans within 24–48 hours for pediatric TBI remains unclear.
- This study assesses the value of repeat cranial CT in children with moderate or severe TBI.
Purpose of the Study:
- To evaluate the diagnostic value of repeat head CT scans in pediatric patients with moderate to severe TBI.
- To determine if clinical examination findings can predict the need for repeat CT.
- To assess the association between neurological status and CT findings.
Main Methods:
- Retrospective study in a pediatric intensive care unit (2000–2006).
- Included survivors of moderate/severe TBI within 24 hours of admission.
- Collected data: age, mechanism, time between CTs, severity scores, Glasgow Coma Scale (GCS) at admission and repeat CT.
Main Results:
- 63 children analyzed; mean age 72 months.
- Repeat CTs averaged 25.78 hours post-initial CT.
- Significant association found between GCS score changes and repeat CT findings (OR=34.5, p=0.000009).
- Positive predictive value: 82%; Negative predictive value: 89%.
Conclusions:
- An unchanged or improving neurological examination in pediatric TBI patients may suffice.
- Clinical monitoring can potentially exclude the need for repeat head CT.
- This could reduce unnecessary neurosurgical interventions and imaging.
Background:
Repeat head computed tomography (CT) is standard practice for traumatic brain injury (TBI) at many centers. The few studies available in children remain unclear over the value of repeat CT within 24 hours to 48 hours of lesion in such patients. The purpose of the present study was to assess the value of repeat cranial CT in children presenting moderate or severe TBI.
Methods:
A retrospective study performed within a pediatric intensive care unit between January 2000 and December 2006. All patients with moderate and severe TBI who survived the first 24 hours after admission were included. Clinical data collected included age, lesion mechanism, time between first and second CTs, disease severity score at admission, and Glasgow Coma Scale (GCS) both at admission and day of repeat CT.
Results:
A total of 63 children were assessed whose mean age was 72 months (48-112). The time between the first and the second CT scans averaged 25.78 hours +/- 13.75 hours (range, 6-48 hours). The reasons for ordering repeat CT scans were divided as follows: follow-up (78%), neurologic deterioration (20.4%), and increased intracranial pressure (1.6%). The change on the follow-up CT scan was compared with the GCS score. The GCS score was improved in 66.6% of patients, remained the same in 15.9%, and worsened in 17.5%. The appearance on the CT scans was better, the same or worse in 41.3%, 34.9%, and 23.8% of patients, respectively. There was a significant association between GCS and changes in findings on repeat CT (OR = 34.5, confidence interval [5.98-199.04], p = 0.000009). The positive and negative predictive values were 82% and 89%, respectively. One patient with a worsened GCS required surgical intervention based on the repeat CT scan.
Conclusion:
An unchanged or improving neurologic examination in children sustaining moderate or severe TBI who are appropriately monitored may be adequate to exclude the possibility of neurosurgical intervention and, hence, repeat head CT scan.
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