Indicações de tomografia de crânio em crianças com trauma cranioencefálico leve (original) (raw)
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Skull radiographs and computed tomography scans in children and adolescents with mild head trauma
Arquivos De Neuro-psiquiatria, 2008
Objective: To identify which pediatric patients with mild head trauma are candidates for skull radiographs or cranial computed tomography (CCT) scans. Method: Patients with mild head trauma aged from 0 to 19 years presenting to the Emergency Department of a trauma centre from Salvador City, Brazil, between May 2007 and May 2008. Results: A total of 1888 mild head trauma patients were admitted; mean age was 7.4 (±5.5) years. A total of 1956 skull radiographs and 734 CCT scans were performed. About 44.4% patients with Glasgow coma score (GCS) 13 and 55.4% with GCS 14 had abnormal CCT scans. In patients with multiple traumas, 16% had abnormal findings on CCT scans. Conclusion: We strongly recommend routine CCT studies to patients with GCS of 13 and 14 or to multiple trauma victims, independently of score. Routine screening skull radiographs were not useful in the evaluation of mild head trauma patients in this study.
Journal of Clinical and Experimental Investigations, 2016
Bu çalışmadaki amacımız hafif kafa travmaları (HKT) olan pediyatrik hastalarda Pediatric Emergency Care Applied Research Network (PECARN) kurallarının bilgisayarlı beyin tomografisi (BBT) gereksinimi konusunda uygulanabilirliğini araştırmaktır. Yöntemler: Bu çalışmada hafif kafa travması ile acile başvuran ve BBT çekilen 317 pediyatrik hasta retrospektif olarak incelenmiştir. Hastalar önce PECARN kuralları gereği iki yaş altı ve iki2 yaş üstü olarak iki gruba ayrıldı; daha sonra bu hasta grupları PECARN kurallarına uyuma göre iki gruba ayrıldı. PECARN kurallarına göre BBT çekilmesi gerekenler PECARN uyumlu (PECARN +) ve gerekmeyip BBT çekilmiş olanlar PECARN uyumsuz (PE-CARN-) olarak gruplandırıldı. Bulgular: BBT sonuçlarına göre incelendiğinde PECARN (+) grubun yaklaşık %20'sinde hastanede yatış süresini arttıran çeşitli patolojiler görülürken PECARN (-) grubun sadece %3,8'inde patoloji görülmüş olup hiçbirinde hastanede 48 saatten fazla takip ihtiyacı olmadı. PECARN (+) grupta BBT çekimini gerektiren en sık görülen bulgular, skalp şişliği veya hematomu ve kusma idi. PECARN (-) grupta en sık görülen bulgular çeşitli büyüklükte skalp kesileri ve dermal abrazyonlar idi. BBT'de fraktür görülmesi PECARN (+) grupta anlamlı derecede yüksek bulundu. Sonuç: BBT ile ciddi radyasyon maruziyeti söz konusu olduğu için minör kafa travmalı çocukların değerlendirilme ve takiplerinde öncelikle nörolojik muayene ve klinik izleme önem verilmesi gerekir. Sonuç olarak, HKT'lı pediyatrik hastalarda BBT kararı için PECARN kuralları yeterlidir.
2024
Among all types of trauma in children, traumatic brain injury has the greatest potential for the development of devastating consequences, with nearly three million affected each year in the world. A controlled, nonrandomized experimental study was carried out in pediatric patients with severe traumatic brain injury, whose objective was to evaluate the use of continuous multimodal neuromonitoring (MMN) of intracranial parameters as a guide in the treatment of children of different age-groups. The patients were divided into two groups according to the treatment received; clinical and imaging monitoring was performed in both. Group I included those whose treatment was guided by MMN of intracranial parameters such as intracranial pressure, cerebral perfusion pressure, and intracranial compliance, and group II included those who had only clinical and imaging monitoring. Eighty patients were studied, 41 in group I and 39 in group II. There were no significant differences between the groups with respect to the sociodemographic variables and the results; as a consequence, both forms of treatment were outlined, for patients with MMN and for those who only have clinical and imaging monitoring. It is concluded that both treatment schemes can be used depending on technological availability, although the scheme with MMN is optimal.
Traumatismo encefalocraneano en pediatría
Revista chilena de pediatría, 2011
Traumatic brain injury in pediatrics Traumatic Brain Injury (TBI) is an important Public Health issue in Chile and the world. It represents a frequent cause of consultation, constituting a signifi cant cause of morbidity and mortality in the population under 45 years of age. Accidents are the main reason for TBI among the pediatric population, but child abuse is an important cause in children below 2 y.o. A proper evaluation is essential to develop timely and effi cient treatment that avoids or decreases brain damage and eventual complications. For this purpose, it is essential that brain physiology and physiopathological changes triggered by TBI are clear and well known. Current concepts are presented in this paper, emphasizing brain hemodynamics, metabolism, and brain self-regulation.
How necessary is computed tomography in pediatric minor head trauma?
Journal of Experimental and Clinical Medicine, 2011
Computerized tomography (CT) is very often used for head injury. Especially in childhood as related to the use of CT is known that a number of drawbacks. At the age of fifteen and under with minor head trauma, it is very difficult to assess whether CT is necessary. The purpose of this study was to assess the necessarity of CT in children who are at 15 years of age and under with minor head trauma. The records of 115 cases who applied with minor head trauma between October 2010-June 2011 to Nevşehir State Hospital Emergency Department, were examined retrospectively. Cases who are 15 years of age and under, with a score of Glascow Coma Scale 15, with a normal neurological examination and applied to emergency service after falls (falls from height, falling from a bicycle, falling on leisure activities), motor vehicle accident, crash and assault were included to study. Forty three (37.4%) were female and 72 (62.6%) were male, while the average age was 7. Among the symptoms, vomiting was the most frequent with 30.4%, while headache was in second place with 19.1%. When we look at the findings, soft tissue swelling was 29.6% in the first place. In all cases CT was taken. Ninety seven (84.4%) patients had normal CTs, while 18 (15.6%) patients had pathology in cranial CT. In cases with pathological cranial CT, 11 (61.1%) patients had linear fracture, 5 (27.7%) patients had depressed fractures, 1 (5.5%) patient had subdural hematoma plus linear fracture and 1 (5.5%) patient had plastering epidural hematoma. In these patients with pathologic cranial CT, 5 (27.7%) of them, (overall 4.3%) underwent surgery. In this study 29.4% of all patients with soft tissue swelling, and 83.3% of all patient with deep incision had pathological cranial CT. There were statistically significant difference between presence of soft tissue swelling, deep incision and pathological cranial CT. (Respectively p = 0.009 and p = 0.001). In children 15 years age and under with minor head trauma, cranial CT should be taken in the presence of soft tissue swelling and deep incision in physical examination.
Medicina Intensiva, 2011
Second level therapeutic maneuvres for controlling intracranial hypertension (ICH) proposed by the European Brain Injury Consortium and the American Association of Neurological Surgeons include barbiturates, moderate hypothermia and more recently the decompressive craniectomy (DC).In most patients, ICP can be maintained below 25 mmHg after a DC. However, the exact effect of DC on brain oxygenation (PtiO2) still unclear. From our point of view the PtiO2 monitoring with the probe located in the healthy area of the most severely damaged cerebral hemisphere is not only a important tool for timing craniectomy in the future but also for evaluating the therapeutic effectivity of DC.
2019
Pediatric head trauma is one of the most important public health issues worldwide and is one of the most common causes of morbidity and mortality in this age group. In infants, trauma of the same severity with adults bring different outcomes as the body structure is different compared to adults. Imaging methods are frequently used in infants presenting with trauma, since children in the 0-2 age group cannot express themselves, their neurological examination is limited and families of infants cannot provide clear information about trauma. The best imaging method for trauma is cranial computed tomography (CCT). In this study, patients aged 0-2 years who applied to an emergency department of a training and research hospital in Istanbul between January 1, 2018 and January 31, 2018 were examined retrospectively. The aim of this study was to determine a clinical pathway by evaluating cranial computed tomography imagings of 0-2 year-old pediatric patients brought to the emergency departme...
Pediatric minor head trauma: do cranial CT scans change the therapeutic approach?
Clinics (Sao Paulo, Brazil), 2016
- To verify clinical signs correlated with appropriate cranial computed tomography scan indications and changes in the therapeutic approach in pediatric minor head trauma scenarios. 2) To estimate the radiation exposure of computed tomography scans with low dose protocols in the context of trauma and the additional associated risk. Investigators reviewed the medical records of all children with minor head trauma, which was defined as a Glasgow coma scale ≥13 at the time of admission to the emergency room, who underwent computed tomography scans during the years of 2013 and 2014. A change in the therapeutic approach was defined as a neurosurgical intervention performed within 30 days, hospitalization, >12 hours of observation, or neuro-specialist evaluation. Of the 1006 children evaluated, 101 showed some abnormality on head computed tomography scans, including 49 who were hospitalized, 16 who remained under observation and 36 who were dismissed. No patient underwent neurosurgery...