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Clinical manifestations that predict abnormal brain computed tomography (CT) in children with minor head injury
Nesrin Alharthy1, Sulaiman Al Queflie2, Khalid Alyousef3
1Department of Emergency Medicine, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia.
Insights
In pediatric patients with head injuries, a Glasgow Coma Scale (GCS) of 13 is the only reliable clinical predictor for intracranial injury, suggesting a potential alternative to CT scans.
Area of Science:
- Pediatric neurology
- Radiology
- Clinical diagnostics
Background:
- Computed tomography (CT) is used for pediatric brain injury (TBI) but carries radiation risks.
- Morbidity and mortality have been reported in children due to CT radiation exposure.
- There is a need for a safe and reliable alternative to CT for diagnosing intracranial injuries.
Purpose of the Study:
- To identify a clinical alternative for detecting intracranial injury in children without using CT scans.
- To evaluate the efficacy of clinical examination in diagnosing pediatric head trauma.
Main Methods:
- Retrospective cross-sectional study of pediatric patients (1-14 years) with blunt head injury and GCS 13-15.
- Statistical analysis to correlate clinical findings with CT results.
- Analysis across different age groups and injury mechanisms.
Main Results:
- No significant association found between loss of consciousness, falls, MVAs, or vomiting and intracranial injury on CT.
- A Glasgow Coma Scale (GCS) of 13 at presentation emerged as the sole significant clinical predictor of intracranial injury.
- Clinical parameters other than GCS showed limited predictive value for intracranial injury.
Conclusions:
- Clinical judgment is crucial for deciding on neuroimaging in pediatric head injury cases.
- Limitations include retrospective data, small sample size, and a restricted number of assessed clinical factors.
- Further research with larger sample sizes is recommended to validate these findings and refine predictive rules.
Background:
Computed tomography (CT) used in pediatric pediatrics brain injury (TBI) to ascertain neurological manifestations. Nevertheless, this practice is associated with adverse effects. Reports in the literature suggest incidents of morbidity and mortality in children due to exposure to radiation. Hence, it is found imperative to search for a reliable alternative.
Objectives:
The aim of this study is to find a reliable clinical alternative to detect an intracranial injury without resorting to the CT.
Materials And Methods:
Retrospective cross-sectional study was undertaken in patients (1-14 years) with blunt head injury and having a Glasgow Coma Scale (GCS) of 13-15 who had CT performed on them. Using statistical analysis, the correlation between clinical examination and positive CT manifestation is analyzed for different age-groups and various mechanisms of injury.
Results:
No statistically significant association between parameteres such as Loss of Consciousness, 'fall' as mechanism of injury, motor vehicle accidents (MVA), more than two discrete episodes of vomiting and the CT finding of intracranial injury could be noted. Analyzed data have led to believe that GCS of 13 at presentation is the only important clinical predictor of intracranial injury.
Conclusion:
Retrospective data, small sample size and limited number of factors for assessing clinical manifestation might present constraints on the predictive rule that was derived from this review. Such limitations notwithstanding, the decision to determine which patients should undergo neuroimaging is encouraged to be based on clinical judgments. Further analysis with higher sample sizes may be required to authenticate and validate findings.
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