Role of routine repeat head imaging in paediatric traumatic brain injury
1Department of Critical Care Medicine, Women's and Children's Hospital, Adelaide, South Australia, Australia.
Insights
Routine repeat head CT scans in children with traumatic brain injuries (TBI) do not change surgical management for mild TBI. Clinically indicated scans are more likely to alter care for moderate to severe TBI.
Area of Science:
- Pediatric Traumatology
- Neuroradiology
- Emergency Medicine
Background:
- Traumatic brain injuries (TBI) are a significant cause of pediatric morbidity and mortality.
- Guidelines for head imaging in pediatric TBI exist, but evidence on routine repeat CT scans is conflicting.
- This study addresses the utility of routine repeat head CT scans in pediatric TBI management.
Purpose of the Study:
- To determine if routine repeat head CT scans alter surgical or medical management in pediatric TBI.
- To evaluate the impact of repeat imaging on clinical decision-making in pediatric head injuries.
Main Methods:
- Retrospective study at a level 1 tertiary pediatric trauma center (2002-2012).
- Included TBI patients with acute intracranial injury and at least one repeat head CT.
- Compared operative management needs between routine and clinically indicated scans.
Main Results:
- 51% of patients (36/71) underwent routine repeat head CT.
- No craniotomies were performed in the routine repeat CT group; 6% (2/36) required delayed ICP monitoring.
- Clinically indicated repeat CT led to ICP monitor or EVD insertion in 3 moderate to severe TBI patients.
Conclusions:
- Repeat head imaging is more beneficial for altering management in moderate to severe pediatric TBI.
- Routine repeat CT scans have no role in managing mild pediatric TBI.
- Clinical status must guide the interpretation of repeat cranial imaging results.
Background:
Paediatric traumatic brain injuries (TBI) remain a leading cause of morbidity and mortality in Australia. There are clear guidelines on head imaging for children with TBI, but there is conflicting evidence on the role of routine repeat head computed tomography (CT) scan. This study aims to determine whether routine repeat head CT scans in paediatric TBI alter surgical or medical management.
Methods:
A retrospective study was performed at a level 1 tertiary paediatric trauma centre between January 2002 and July 2012. Patients with TBI who were admitted with acute intracranial injury and at least one repeat head CT scan were included. Mechanism of injury, severity of TBI, Glasgow Coma Score, use of intracranial pressure monitoring and operative procedures were listed. The need for operative management was compared for routine and clinically indicated head scans.
Results:
Routine head CT scan was done in 36 out of 71 patients (51%). None from this group required craniotomy, but two children (6%) needed delayed ICP monitoring. Three patients with moderate to severe TBI required intracranial pressure monitor or external ventricular drain insertion based on a clinically indicated repeat head CT.
Conclusion:
Repeat head imaging is more likely to alter management of children with moderate to severe TBI. There is no role for routine repeat CT scan on mild TBI. Results of repeat cranial imaging should be correlated with the clinical status of the patient.
More Related Videos
07:02An Investigation of the Effects of Sports-related Concussion in Youth Using Functional Magnetic Resonance Imaging and the Head Impact Telemetry System
Published on: January 12, 2011
15:18Making MR Imaging Child's Play - Pediatric Neuroimaging Protocol, Guidelines and Procedure
Published on: July 30, 2009
