The role of repeat computerized cranial tomography in pediatric blunt head trauma

Sertaç Güler 1 * , Dilber Üçöz Kocaşaban 1, Yahya Kemal Günaydın 1
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1 Department of Emergency Medicine, Ankara Training and Research Hospital, University of Health Sciences, Ankara, Turkey
* Corresponding Author
J CLIN MED KAZ, Volume 20, Issue 4, pp. 22-26. https://doi.org/10.23950/jcmk/13494
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ABSTRACT

Introduction: Computed cranial tomography (CCT) is commonly used in emergency departments (EDs) for pediatric blunt head injury (BHI) management. Cranial tomography is also repeated often unnecessarily due to physicians’ concerns about detecting the early onset of a possible new injury or progression of an existing one. This study aims to evaluate whether routine RCCT provides a significant change in patient management.
Material and methods: The study was performed as a 2-year retrospective analysis in the ED of a tertiary hospital. The medical records of pediatric BHI patients were reviewed, and the study included accessed data of 104 patients who underwent at least two CCT during their stay in the ED.
Results: The study included 104 out of 533 BHI patients. The mean age of these 104 patients was 6.2 years (median=4.5 years), and the majority were male (n=82, 78.9%). When the initial CCT results of the patients were analyzed, it was found that 51% (n=53) of the tomography results were normal. While there were substantial changes in 7 of the RCCTs, there were no significant changes in 97. Only 4 of these 7 patients who had significant changes were taken to the emergent operating room. None of these patients belonged to the group of patients whose CCT was classified as "normal" on admission (p<0.05).
Conclusion: According to our results, routine RCCT for BHI in pediatric patients did not result in a significant change in patient management.
Keywords: Blunt head injury, computed tomography, pediatric emergency medicine, radiation exposure

CITATION

Güler S, Üçöz Kocaşaban D, Günaydın YK. The role of repeat computerized cranial tomography in pediatric blunt head trauma. J CLIN MED KAZ. 2023;20(4):22-6. https://doi.org/10.23950/jcmk/13494

REFERENCES

  • Hill EP, Stiles PJ, Reyes J, Nold RJ, Helmer SD, Haan JM. Repeat head imaging in blunt pediatric trauma patients: Is it necessary? J Trauma Acute Care Surg. 2017;82(5):896-900. https://doi.org/10.1097/TA.0000000000001406
  • Howe J, Fitzpatrick CM, Lakam DR, Gleisner A, Vane DW. Routine repeat brain computed tomography in all children with mild traumatic brain injury may result in unnecessary radiation exposure. J Trauma Acute Care Surg. 2014;76(2):292-6. https://doi.org/10.1097/TA.0000000000000119
  • da Silva PS, Reis ME, Aguiar VE. Value of repeat cranial computed tomography in pediatric patients sustaining moderate to severe traumatic brain injury. J Trauma. 2008;65(6):1293-7. https://doi.org/10.1097/TA.0b013e318156866c
  • Kuppermann N, Holmes JF, Dayan PS, Hoyle JD Jr, et al. Pediatric Emergency Care Applied Research Network (PECARN). Identification of children at very low risk of clinically-important brain injuries after head trauma: a prospective cohort study. Lancet. 2009;374(9696):1160-70. https://doi.org/10.1016/S0140-6736(09)61558-0
  • Dunning J, Daly JP, Lomas JP, Lecky F, Batchelor J, Mackway-Jones K. Children's head injury algorithm for the prediction of important clinical events study group. Derivation of the children's head injury algorithm for the prediction of important clinical events decision rule for head injury in children. Arch Dis Child. 2006;91(11):885-91. https://doi.org/10.1136/adc.2005.083980
  • Osmond MH, Klassen TP, Wells GA, Correll R, et al. Pediatric Emergency Research Canada (PERC) Head Injury Study Group. CATCH: a clinical decision rule for the use of computed tomography in children with minor head injury. CMAJ. 2010;182(4):341-8. https://doi.org/10.1503/cmaj.091421
  • Aziz H, Rhee P, Pandit V, Ibrahim-Zada I, et al. Mild and moderate pediatric traumatic brain injury: replace routine repeat head computed tomography with neurologic examination. J Trauma Acute Care Surg. 2013;75(4):550-4. https://doi.org/10.1097/TA.0b013e3182a53a77
  • Brown CV, Zada G, Salim A, Inaba K, et al. Indications for routine repeat head computed tomography (CT) stratified by severity of traumatic brain injury. J Trauma. 2007;62(6):1339-45. https://doi.org/10.1097/TA.0b013e318054e25a
  • Brenner D, Elliston C, Hall E, Berdon W. Estimated risks of radiation-induced fatal cancer from pediatric CT. AJR Am J Roentgenol. 2001;176(2):289-96. https://doi.org/10.2214/ajr.176.2.1760289
  • Hall P, Adami HO, Trichopoulos D, Pedersen NL, et al. Effect of low doses of ionising radiation in infancy on cognitive function in adulthood: Swedish population based cohort study. BMJ. 2004;328(7430):19. https://doi.org/10.1136/bmj.328.7430.19
  • Stippler M, Smith C, McLean AR, Carlson A, et al. Utility of routine follow-up head CT scanning after mild traumatic brain injury: a systematic review of the literature. Emerg Med J. 2012;29(7):528-32. https://doi.org/10.1136/emermed-2011-200162
  • Figg RE, Burry TS, Vander Kolk WE. Clinical efficacy of serial computed tomographic scanning in severe closed head injury patients. J Trauma. 2003;55(6):1061-4. https://doi.org/10.1097/01.TA.0000096712.90133.5C
  • Schnadower D, Vazquez H, Lee J, Dayan P, Roskind CG. Controversies in the evaluation and management of minor blunt head trauma in children. Curr Opin Pediatr. 2007;19(3):258-64. https://doi.org/10.1097/MOP.0b013e3281084e85
  • Hollingworth W, Vavilala MS, Jarvik JG, Chaudhry S, et al. The use of repeated head computed tomography in pediatric blunt head trauma: factors predicting new and worsening brain injury. Pediatr Crit Care Med. 2007;8(4):348-56. https://doi.org/10.1097/01.PCC.0000270837.66217.3B
  • Bata SC, Yung M. Role of routine repeat head imaging in paediatric traumatic brain injury. ANZ J Surg. 2014;84(6):438-41. https://doi.org/10.1111/ans.12582
  • Almenawer SA, Bogza I, Yarascavitch B, Sne N, et al. The value of scheduled repeat cranial computed tomography after mild head injury: single-center series and meta-analysis. Neurosurgery. 2013;72(1):56-64. https://doi.org/10.1227/NEU.0b013e318276f899
  • Schonfeld D, Bressan S, Da Dalt L, Henien MN, Winnett JA, Nigrovic LE. Pediatric Emergency Care Applied Research Network head injury clinical prediction rules are reliable in practice. Arch Dis Child. 2014;99(5):427-31. https://doi.org/10.1136/archdischild-2013-305004
  • AbdelFattah KR, Eastman AL, Aldy KN, Wolf SE, et al. A prospective evaluation of the use of routine repeat cranial CT scans in patients with intracranial hemorrhage and GCS score of 13 to 15. J Trauma Acute Care Surg. 2012;73(3):685-8. https://doi.org/10.1097/TA.0b013e318265ccd9
  • Joseph B, Aziz H, Pandit V, Kulvatunyou N, et al. A three-year prospective study of repeat head computed tomography in patients with traumatic brain injury. J Am Coll Surg. 2014;219(1):45-51. https://doi.org/10.1016/j.jamcollsurg.2013.12.062
  • Utsumi S, Ohnishi S, Amagasa S, Sasaki R, Uematsu S, Kubota M. Role of Routine Repeat Head CT for Pediatric Patients under 2 Years Old with Mild-to-moderate Traumatic Brain Injury. Neurol Med Chir (Tokyo). 2022;62(3):133-139. https://doi.org/10.2176/nmc.oa.2021-0221
  • Engel EP, Bitter B, Reyes J, Grundmeyer R, Helmer SD, Haan JM. Should Infants with Blunt Traumatic Brain Injuries and Intracranial Hemorrhage Have Routine Repeat Imaging? Kans J Med. 2023;16:117-120. https://doi.org/10.17161/kjm.vol16.19209