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Is Routine Repeated Head CT Necessary for All Pediatric Traumatic Brain Injury?
Won-Hyung Kim1, Dong-Jun Lim1, Se-Hoon Kim1
1Department of Neurosurgery, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea.
Insights
Pediatric traumatic brain injury patients with epidural hemorrhage over 10 cc or Glasgow Coma Scale below 9 require repeated head CT scans, even without clinical decline. This helps identify progression and guides timely surgical intervention.
Area of Science:
- Pediatric Traumatology
- Neuroradiology
- Neurocritical Care
Background:
- Repeated computed tomography (CT) scans are common for pediatric traumatic brain injury (TBI) patients.
- Indications for repeat CT scans in this population remain debated.
- Identifying risk factors for disease progression and delayed surgical intervention is crucial.
Purpose of the Study:
- To identify risk factors for progression on repeated CT scans in pediatric TBI patients.
- To determine predictors of delayed surgical intervention based on repeated head CT findings.
Main Methods:
- Retrospective analysis of 269 pediatric patients (age 0-18) admitted for head trauma.
- Classification into 8 injury mechanism subgroups.
- Analysis of hemorrhage types, volume, changes on repeat CT, and initial Glasgow Coma Scale (GCS) scores.
Main Results:
- 174 of 269 patients received repeat CT; 48 (27.6%) showed hemorrhage progression.
- Epidural hemorrhage (EDH) >10 cc on initial CT was a significant risk factor for delayed surgery.
- Severe head trauma (GCS 3-8) also predicted delayed surgical intervention, irrespective of clinical changes.
Conclusions:
- Patients with EDH >10 cc or GCS <9 warrant repeat head CT, even without significant clinical deterioration.
- These findings aid in optimizing follow-up imaging strategies for pediatric TBI.
- Early identification of at-risk patients can facilitate timely surgical management.
Objective:
Repeated computed tomography (CT) follow up for traumatic brain injury (TBI) patients is often performed. But there is debate the indication for repeated CT scans, especially in pediatric patients. Purpose of our study is to find risk factors of progression on repeated CT and delayed surgical intervention based on the repeated head CT.
Methods:
Between March, 2007 and December, 2013, 269 pediatric patients (age 0-18 years) had admitted to our hospital for head trauma. Patients were classified into 8 subgroups according to mechanisms of injury. Types, amount of hemorrhage and amount changes on repeated CT were analyzed as well as initial Glasgow Coma Scale (GCS) scores.
Results:
Within our cohort of 269 patients, 174 patients received repeat CT. There were progression in the amount of hemorrhage in 48 (27.6%) patients. Among various hemorrhage types, epidural hemorrhage (EDH) more than 10 cc measured in initial CT was found to be at risk of delayed surgical intervention significantly after routine repeated CT with or without neurological deterioration than other types of hemorrhage. Based on initial GCS, severe head trauma group (GCS 3-8) was at risk of delayed surgical intervention after routine repeated CT without change of clinical neurologic status.
Conclusion:
We suggest that the patients with EDH more than 10 cc or GCS below 9 should receive repeated head CT even though absence of significant clinical deterioration.
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