Computerized tomography and prognosis in paediatric head injury
1Department of Neurology and Neurosurgery, Tartu University Hospital, Estonia.
Insights
Computerized tomography (CT) in pediatric head injuries (HI) reveals diffuse brain swelling as common. Despite varied outcomes, children with severe HI generally fare better than adults, warranting inclusion in rehabilitation.
Area of Science:
- Pediatric Neurology
- Neuroradiology
- Traumatology
Background:
- Head injuries (HI) in children and adolescents present unique challenges in diagnosis and prognosis.
- Computerized tomography (CT) is crucial for evaluating the morphologic manifestations of HI in pediatric patients.
- Understanding the correlation between CT findings, clinical status, and patient outcomes is vital for effective management.
Purpose of the Study:
- To analyze CT findings in pediatric head injuries.
- To correlate CT findings with clinical state and early/late outcomes in children and adolescents.
- To compare pediatric HI outcomes with adult data and inform rehabilitation strategies.
Main Methods:
- Analysis of clinical and CT data from 82 consecutive pediatric HI patients (<18 years).
- Evaluation of morphologic manifestations of HI using CT scans.
- Assessment of patient outcomes using the Lidcombe impairment scale at 3, 6 months, 1, and 2 years post-injury.
Main Results:
- Diffuse brain swelling with ventricular/cisternal compression was the most frequent CT finding in pediatric HI.
- Prognostically unfavorable CT findings included shearing injury, intracerebral/subdural hematomas, brain swelling, and parenchymal damage.
- Outcomes two years after severe HI varied significantly but were generally better in children than adults.
Conclusions:
- CT findings in pediatric HI differ from adults in presentation and outcome.
- Despite long-term quality of life disruptions, no individual outcome predictors exist for pediatric HI.
- All children with head injuries should be considered for early and long-term rehabilitation programs.
Abstract:
The authors have analysed the computerized tomography (CT) findings and their correlation with the clinical state, early and late outcome in children and adolescents with head injuries (HI). This study represents clinical and CT data of 82 consecutive HI patients under 18 years of age. Among them 51 (62%) were boys and 31 (38%) girls. The application of CT to the evaluation of the morphologic manifestations of HI in children has shown some differences in forms and mechanisms of injury and in outcome compared to adults. In the paediatric HI the most frequent finding was diffuse brain swelling with CT evidence of ventricular and cisternal compression or obliteration. Prognostically the most unfavourable findings were shearing injury, intracerebral and subdural haematomas combined with brain swelling and parenchymal damage. According to the Lidcombe impairment scale, outcome from severe paediatric HI was determined in the 3rd and 6th months, one year and 2 years after the injury. The outcome two years after severe HI varied to a great extent and was better in children than in adults. Although there was long-term disruption of the patient's quality of life, our data show that as there are no predictors of individual outcomes in child HI, no child should be excluded from early and long-term rehabilitation.
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