Utility of serial computed tomography imaging in pediatric patients with head trauma. 2006

Susan R Durham, and Kenneth C Liu, and Nathan R Selden
Department of Neurological Surgery, Division of Pediatric Neurosurgery, Doernbecher Children's Hospital, Oregon Health and Science University, Portland, Oregon, USA. srd@hitchcock.org

OBJECTIVE The purpose of this study was to evaluate the risk of progression of traumatic intracranial lesions in children by comparing initial and subsequent computed tomography (CT) scans. Reserving repeated CT imaging for patients who harbor higher-risk lesions may reduce overall radiation exposure, the need for sedative agents, and cost. METHODS The authors performed a retrospective cohort study in 268 patients younger than 18 years of age who underwent repeated CT scanning within 24 hours of their initial CT scanning procedure. The risk of progression between the initial and repeated CT scanning sessions and the need for delayed neurosurgical intervention were determined for each lesion type. In 54 patients (20.1%) the normal findings on the initial CT study did not change on subsequent imaging. In 61 (28.5%) of the 214 patients in whom abnormal findings were present on the initial scan, progression was demonstrated. Patients with epidural hematoma (EDH; odds ratio [OR] 12.29), subdural hematoma (SDH; OR 3.18), cerebral edema (OR 9.34), and intraparenchymal hemorrhage (IPH; OR 18.3) were found to be at a significantly increased risk for progression and to require delayed neurosurgical intervention (OR 11.91). No significantly increased risk was found for patients with subarachnoid hemorrhage (SAH), intraventricular hemorrhage (IVH), diffuse axonal injury (DAI), or skull fracture. CONCLUSIONS Repeated CT imaging in children with high-risk lesions such as EDH, SDH, cerebral edema, and IPH is recommended. However, in children with low-risk lesions, such as SAH, IVH, DAI, and isolated skull fractures but no sign of clinical deterioration, repeated imaging may be less likely to alter the clinical management scheme. The limited benefits of undertaking repeated imaging in these patients should be weighed against the risks of radiation exposure, sedation, intrahospital transportation, and patient monitoring.

UI MeSH Term Description Entries
D007223 Infant A child between 1 and 23 months of age. Infants
D007231 Infant, Newborn An infant during the first 28 days after birth. Neonate,Newborns,Infants, Newborn,Neonates,Newborn,Newborn Infant,Newborn Infants
D008297 Male Males
D001929 Brain Edema Increased intracellular or extracellular fluid in brain tissue. Cytotoxic brain edema (swelling due to increased intracellular fluid) is indicative of a disturbance in cell metabolism, and is commonly associated with hypoxic or ischemic injuries (see HYPOXIA, BRAIN). An increase in extracellular fluid may be caused by increased brain capillary permeability (vasogenic edema), an osmotic gradient, local blockages in interstitial fluid pathways, or by obstruction of CSF flow (e.g., obstructive HYDROCEPHALUS). (From Childs Nerv Syst 1992 Sep; 8(6):301-6) Brain Swelling,Cerebral Edema,Cytotoxic Brain Edema,Intracranial Edema,Vasogenic Cerebral Edema,Cerebral Edema, Cytotoxic,Cerebral Edema, Vasogenic,Cytotoxic Cerebral Edema,Vasogenic Brain Edema,Brain Edema, Cytotoxic,Brain Edema, Vasogenic,Brain Swellings,Cerebral Edemas, Vasogenic,Edema, Brain,Edema, Cerebral,Edema, Cytotoxic Brain,Edema, Cytotoxic Cerebral,Edema, Intracranial,Edema, Vasogenic Brain,Edema, Vasogenic Cerebral,Swelling, Brain
D002543 Cerebral Hemorrhage Bleeding into one or both CEREBRAL HEMISPHERES including the BASAL GANGLIA and the CEREBRAL CORTEX. It is often associated with HYPERTENSION and CRANIOCEREBRAL TRAUMA. Brain Hemorrhage, Cerebral,Cerebral Parenchymal Hemorrhage,Hemorrhage, Cerebral,Intracerebral Hemorrhage,Hemorrhage, Cerebrum,Brain Hemorrhages, Cerebral,Cerebral Brain Hemorrhage,Cerebral Brain Hemorrhages,Cerebral Hemorrhages,Cerebral Parenchymal Hemorrhages,Cerebrum Hemorrhage,Cerebrum Hemorrhages,Hemorrhage, Cerebral Brain,Hemorrhage, Cerebral Parenchymal,Hemorrhage, Intracerebral,Hemorrhages, Cerebral,Hemorrhages, Cerebral Brain,Hemorrhages, Cerebral Parenchymal,Hemorrhages, Cerebrum,Hemorrhages, Intracerebral,Intracerebral Hemorrhages,Parenchymal Hemorrhage, Cerebral,Parenchymal Hemorrhages, Cerebral
D002648 Child A person 6 to 12 years of age. An individual 2 to 5 years old is CHILD, PRESCHOOL. Children
D002675 Child, Preschool A child between the ages of 2 and 5. Children, Preschool,Preschool Child,Preschool Children
D005260 Female Females
D006259 Craniocerebral Trauma Traumatic injuries involving the cranium and intracranial structures (i.e., BRAIN; CRANIAL NERVES; MENINGES; and other structures). Injuries may be classified by whether or not the skull is penetrated (i.e., penetrating vs. nonpenetrating) or whether there is an associated hemorrhage. Frontal Region Trauma,Head Injuries,Head Trauma,Occipital Region Trauma,Parietal Region Trauma,Temporal Region Trauma,Craniocerebral Injuries,Crushing Skull Injury,Forehead Trauma,Head Injuries, Multiple,Head Injury, Minor,Head Injury, Open,Head Injury, Superficial,Injuries, Craniocerebral,Injuries, Head,Multiple Head Injuries,Occipital Trauma,Open Head Injury,Superficial Head Injury,Trauma, Head,Craniocerebral Injury,Craniocerebral Traumas,Crushing Skull Injuries,Forehead Traumas,Frontal Region Traumas,Head Injuries, Minor,Head Injuries, Open,Head Injuries, Superficial,Head Injury,Head Injury, Multiple,Head Traumas,Injuries, Minor Head,Injuries, Multiple Head,Injuries, Open Head,Injuries, Superficial Head,Injury, Craniocerebral,Injury, Head,Injury, Minor Head,Injury, Multiple Head,Injury, Open Head,Injury, Superficial Head,Minor Head Injuries,Minor Head Injury,Multiple Head Injury,Occipital Region Traumas,Occipital Traumas,Open Head Injuries,Parietal Region Traumas,Region Trauma, Frontal,Region Trauma, Occipital,Region Trauma, Parietal,Region Traumas, Frontal,Region Traumas, Occipital,Region Traumas, Parietal,Skull Injuries, Crushing,Skull Injury, Crushing,Superficial Head Injuries,Temporal Region Traumas,Trauma, Craniocerebral,Trauma, Forehead,Trauma, Frontal Region,Trauma, Occipital,Trauma, Occipital Region,Trauma, Parietal Region,Trauma, Temporal Region,Traumas, Craniocerebral,Traumas, Forehead,Traumas, Frontal Region,Traumas, Head,Traumas, Occipital,Traumas, Occipital Region,Traumas, Parietal Region,Traumas, Temporal Region
D006407 Hematoma, Epidural, Cranial Accumulation of blood in the EPIDURAL SPACE between the SKULL and the DURA MATER, often as a result of bleeding from the MENINGEAL ARTERIES associated with a temporal or parietal bone fracture. Epidural hematoma tends to expand rapidly, compressing the dura and underlying brain. Clinical features may include HEADACHE; VOMITING; HEMIPARESIS; and impaired mental function. Cranial Epidural Hematoma,Hemorrhage, Cranial Epidural,Epidural Hemorrhage, Cranial,Extradural Hematoma, Cranial,Extradural Hemorrhage, Cranial,Hematoma, Epidural, Intracranial,Intracranial Epidural Hematoma,Cranial Epidural Hematomas,Cranial Epidural Hemorrhage,Cranial Epidural Hemorrhages,Cranial Extradural Hematoma,Cranial Extradural Hematomas,Cranial Extradural Hemorrhage,Cranial Extradural Hemorrhages,Epidural Hematoma, Cranial,Epidural Hematoma, Intracranial,Epidural Hematomas, Cranial,Epidural Hematomas, Intracranial,Epidural Hemorrhages, Cranial,Extradural Hematomas, Cranial,Extradural Hemorrhages, Cranial,Hematoma, Cranial Epidural,Hematoma, Cranial Extradural,Hematoma, Intracranial Epidural,Hematomas, Cranial Epidural,Hematomas, Cranial Extradural,Hematomas, Intracranial Epidural,Hemorrhage, Cranial Extradural,Hemorrhages, Cranial Epidural,Hemorrhages, Cranial Extradural,Intracranial Epidural Hematomas

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