Indications for computed tomography use and frequency of traumatic abnormalities based on real-world data of 2405 pediatric patients with minor head trauma

Background: In pediatric patients with minor head trauma, computed tomography (CT) is often performed beyond the scope of recommendations that are based on existing algorithms. Herein, we evaluated pediatric patients with minor head trauma who underwent CT examinations, quantified its frequency, and determined how often traumatic findings were observed in the intracranial region or skull. Methods: We retrospectively reviewed the medical records and neuroimages of pediatric patients (0–5 years) who presented at our hospital with minor head trauma within 24 h after injury. Results: Of 2405 eligible patients, 1592 (66.2%) underwent CT examinations and 45 (1.9%) had traumatic intracranial hemorrhage or skull fracture on CT. No patient underwent surgery or intensive treatment. Multivariate analyses revealed that an age of 1–5 years (vs. <1 year; P < 0.001), Glasgow Coma Scale (GCS) score of 14 (vs. a score of 15; P = 0.008), sustaining a high-altitude fall (P < 0.001), using an ambulance (P < 0.001), and vomiting (P < 0.001) were significantly associated with the performance of CT examination. In addition, traumatic abnormalities on CT were significantly associated with the combination of an age of under 1 year (P = 0.042), GCS score of 14 (P < 0.001), and sustaining a high-altitude fall (P = 0.004). Conclusion: Although slightly broader indications for CT use, compared to the previous algorithms, could detect and evaluate minor traumatic changes in pediatric patients with minor head trauma, over-indications for CT examinations to detect only approximately 2% of abnormalities should be avoided and the indications should be determined based on the patient’s age, condition, and cause of injury.

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Pediatric Minor Head Trauma: Factors Affecting the Anxiety of Parents

Clinical Pediatrics ◽

10.1177/00099228211009678 ◽

2021 ◽

pp. 000992282110096

Author(s):

Hasan Aldinc ◽

Cem Gun ◽

Serpil Yaylaci ◽

Erol Barbur

Keyword(s):

Computed Tomography ◽

Head Trauma ◽

Pediatric Patients ◽

Positive Impact ◽

Cranial Computed Tomography ◽

Sufficient Information ◽

Minor Head Trauma ◽

Computed Tomography Imaging ◽

Factors Affecting ◽

X Ray

Managing the anxiety of the parents of pediatric patients with head trauma is challenging. This study aimed to examine the factors that affect anxiety levels of parents whose children were admitted to the emergency department with minor head trauma. In this prospective study, the parents of 663 consecutive pediatric patients were invited to answer a questionnaire. Parents of 600 children participated in the study. The parents who believed they were provided sufficient information and who were satisfied with the service received had significantly more improvement in anxiety-related questions. Cranial X-ray assessment had a significantly positive impact on the anxiety of the parents, whereas cranial computed tomography and neurosurgery consultation did not. In assessing pediatric minor head trauma, cranial computed tomography imaging and neurosurgery consultation should not be expected to relieve the anxiety of the parents. However, adequately informing them and providing satisfaction are the factors that could lead to improvement.

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Minor head trauma and linear skull fracture in infants: cranial ultrasound or computed tomography?

European Journal of Emergency Medicine ◽

10.1097/mej.0b013e328321b7b5 ◽

2009 ◽

Vol 16 (3) ◽

pp. 150-152 ◽

Cited By ~ 14

Author(s):

Victoria Trenchs ◽

Ana I. Curcoy ◽

Marta Castillo ◽

Josep Badosa ◽

Carles Luaces ◽

...

Keyword(s):

Computed Tomography ◽

Head Trauma ◽

Skull Fracture ◽

Cranial Ultrasound ◽

Minor Head Trauma

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Diagnostic and Clinical Management of Skull Fractures in Children

Journal of Clinical Imaging Science ◽

10.4103/2156-7514.194261 ◽

2016 ◽

Vol 6 ◽

pp. 47

Author(s):

Christoph Arneitz ◽

Maria Sinzig ◽

Günter Fasching

Keyword(s):

Hospital Stay ◽

Head Trauma ◽

Clinical Management ◽

Skull Fracture ◽

Neurological Symptoms ◽

Ct Scans ◽

Skull Fractures ◽

X Rays ◽

Minor Head Trauma ◽

The Mean

Objective: The indications of routine skull X-rays after mild head trauma are still in discussion, and the clinical management of a child with a skull fracture remains controversial. The aim of our retrospective study was to evaluate our diagnostic and clinical management of children with skull fractures following minor head trauma. Methods: We worked up the medical history of all consecutive patients with a skull fracture treated in our hospital from January 2009 to October 2014 and investigated all skull X-rays in our hospital during this period. Results: In 5217 skull radiographies, 66 skull fractures (1.3%) were detected. The mean age of all our patients was 5.9 years (median age: 4.0 years); the mean age of patients with a diagnosed skull fracture was 2.3 years (median age: 0.8 years). A total of 1658 children (32%) were <2 years old. A typical boggy swelling was present in 61% of all skull fractures. The majority of injuries were caused by falls (77%). Nine patients (14%) required a computed tomography (CT) scan during their hospital stay due to neurological symptoms, and four patients had a brain magnetic resonance imaging. Nine patients (14%) showed an intracranial hemorrhage (ICH; mean age: 7.3 years); one patient had a neurosurgery because of a depressed skull fracture. Nine patients (14%) were observed at our pediatric intensive care unit for a mean time of 2.9 days. The mean hospital stay was 4.2 days. Conclusions: Our findings support previous evidence against the routine use of skull X-rays for evaluation of children with minor head injury. The rate of diagnosed skull fractures in radiographs following minor head trauma is low, and additional CT scans are not indicated in asymptomatic patient with a linear skull fracture. All detected ICHs could be treated conservatively. Children under the age of 2 years have the highest risk of skull fractures after minor head trauma, but do not have a higher incidence of intracranial bleeding. Neuroobservation without initial CT scans is safe in infants and children following minor head trauma and CT scans should be reserved for patients with neurological symptoms.

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Endovascular Treatment of Traumatic Intracranial Aneurysm in an Infant

Interventional Neuroradiology ◽

10.1177/159101990300900210 ◽

2003 ◽

Vol 9 (2) ◽

pp. 199-204 ◽

Cited By ~ 6

Author(s):

B. Kim ◽

S.-K. Lee ◽

K.G. terBrugge

Keyword(s):

Intracranial Aneurysm ◽

Endovascular Treatment ◽

Head Trauma ◽

Intracranial Hemorrhage ◽

Skull Fracture ◽

Closed Head Injury ◽

Anterior Communicating Artery ◽

Delayed Presentation ◽

Minor Head Trauma ◽

Traumatic Aneurysm

Traumatic intracranial aneurysms in children are rare and mostly related to skull fracture or rapid decelerating closed head injury. We report the case of an infant who developed intracranial aneurysm after minor head trauma and managed by endovascular treatment. A seven-month-old infant presented with delayed intracranial hemorrhage following minor head trauma. Cerebral angiography disclosed a multilobulated fusiform aneurysm involving the right anterior cerebral artery (ACA) distal to the anterior communicating artery. Endovascular treatment of the aneurysm was performed and the infant made an excellent recovery during six months clinical and radiological follow-up. Delayed presentation of intracranial hemorrhage with acute deterioration in the infant after head trauma warrants angiography for proper diagnosis and management of the traumatic aneurysm, which has a high mortality rate after rupture and rebleeding. Endovascular treatment of traumatic aneurysm is feasible in infants, and occlusion of distal intracranial arterial aneurysms can be safely and precisely achieved using current coil technology.

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Can a CT be Omitted in Pediatric Minor Head Trauma?

Journal of Pediatric Neurology ◽

10.1055/s-0037-1604420 ◽

2017 ◽

Vol 16 (01) ◽

pp. 001-007

Author(s):

Maria Sinzig ◽

Eveline Achatz ◽

Günter Fasching ◽

Christoph Arneitz

Keyword(s):

Computed Tomography ◽

Ct Scan ◽

Radiation Exposure ◽

Head Trauma ◽

Neurological Status ◽

Ct Scans ◽

Minor Head Trauma ◽

Pediatric Ct ◽

Ct Protocol ◽

In Infants And Children

AbstractThis study aimed to evaluate the need for radiation exposure in pediatric minor head trauma. Symptomatic patients after minor head trauma were observed for at least 24 hours in a 13-month period. A computed tomography (CT) scan was performed on children with a depressed neurological status. Two hundred fourteen patients with a mean age of 9.3 years were included. An intracranial hemorrhage (ICH) was diagnosed in three (1.4%) patients. The overall CT rate was 10.7%. The study concluded that neuro-observation without initial CT scans is safe in infants and children following minor head trauma. Special pediatric CT protocol can limit radiation exposure.

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Risk factors indicating the need for cranial CT scans in elderly patients with head trauma: an Austrian trial and comparison with the Canadian CT Head Rule

Journal of Neurosurgery ◽

10.3171/2013.10.jns13726 ◽

2014 ◽

Vol 120 (2) ◽

pp. 447-452 ◽

Cited By ~ 11

Author(s):

Harald Wolf ◽

Wolfgang Machold ◽

Sophie Frantal ◽

Mathias Kecht ◽

Gholam Pajenda ◽

...

Keyword(s):

Risk Factors ◽

Intensive Care ◽

Elderly Patients ◽

Head Trauma ◽

Skull Fracture ◽

Loss Of Consciousness ◽

Cranial Ct ◽

Ct Head ◽

Gcs Score ◽

Neurosurgical Intervention

Object This study presents newly defined risk factors for detecting clinically important brain injury requiring neurosurgical intervention and intensive care, and compares it with the Canadian CT Head Rule (CCHR). Methods This prospective cohort study was conducted in a single Austrian Level-I trauma center and enrolled a consecutive sample of mildly head-injured adults who presented to the emergency department with witnessed loss of consciousness, disorientation, or amnesia, and a Glasgow Coma Scale (GCS) score of 13–15. The studied population consisted of a large number of elderly patients living in Vienna. The aim of the study was to investigate risk factors that help to predict the need for immediate cranial CT in patients with mild head trauma. Results Among the 12,786 enrolled patients, 1307 received a cranial CT scan. Four hundred eighty-nine patients (37.4%) with a mean age of 63.9 ± 22.8 years had evidence of an acute traumatic intracranial lesion on CT. Three patients (< 0.1%) were admitted to the intensive care unit for neurological observation and received oropharyngeal intubation. Seventeen patients (0.1%) underwent neurosurgical intervention. In 818 patients (62.6%), no evidence of an acute trauma-related lesion was found on CT. Data analysis showed that the presence of at least 1 of the following factors can predict the necessity of cranial CT: amnesia, GCS score, age > 65 years, loss of consciousness, nausea or vomiting, hypocoagulation, dementia or a history of ischemic stroke, anisocoria, skull fracture, and development of a focal neurological deficit. Patients requiring neurosurgical intervention were detected with a sensitivity of 90% and a specificity of 67% by using the authors' analysis. In contrast, the use of the CCHR in these patients detected the need for neurosurgical intervention with a sensitivity of only 80% and a specificity of 72%. Conclusions The use of the suggested parameters proved to be superior in the detection of high-risk patients who sustained a mild head trauma compared with the CCHR rules. Further validation of these results in a multicenter setting is needed. Clinical trial registration no.: NCT00451789 (ClinicalTrials.gov.)

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Timing of presentation and correlation with computed tomography in pediatric patients with minor head trauma

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20184256 ◽

2018 ◽

Vol 5 (6) ◽

pp. 2038

Author(s):

Karthick Jayapal ◽

Hassan Adnan Mansour

Keyword(s):

Computed Tomography ◽

Head Trauma ◽

Cross Sectional Study ◽

Minor Head Trauma ◽

Cross Sectional ◽

Increased Risk ◽

Key Factor ◽

History Of ◽

Study Participants ◽

Type Of Injury

Background: The presentation of minor head trauma warrants immediate and accurate diagnosis for early clinical management among children. Computed Tomography is the gold standard tool for the diagnosis of Traumatic Brain Injury (TBI) among the children. The timing of presentation may have a significant role in predicting the incidence of TBI. This study was done to compare the CT findings among children who presented within and after 24 hours with minor head trauma.Methods: This cross-sectional study was carried out among 992 children between 2-15 years reporting with a history of head injury. All the participants were clinically examined, and relevant history of type of injury and timing of presentation was recorded. CT scan was taken as per PECARN criteria. Data was entered and analysed using SPSS ver 15 software.Results: Majority of the participants belonged to 6-10 years of age (45.2%) and were males (58.5%). About 81.7% of the participants presented within 24 hours. The overall prevalence of TBI among the study participants was 58.6% [55.5-61.6].It was observed that hematoma predominantly presented after 24 hours (74.2%) and majority of the falls presented after 24 hours (92.8%).Patients who presented after 24 hours were at increased risk of presenting as TBI (67.03%) compared to those presenting within 24 hours (56.8%;p<0.05).Conclusions: This study has emphasized the need for including the timing of presentation as a key factor for facilitating early diagnosis and rapid case management of pediatric head trauma.

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