scholarly journals Fusion patterns of minor lateral calvarial sutures on volume-rendered CT reconstructions

2020 ◽  
Vol 26 (2) ◽  
pp. 200-210
Author(s):  
C. Corbett Wilkinson ◽  
Cesar A. Serrano ◽  
Brooke M. French ◽  
Sarah J. Graber ◽  
Emily Schmidt-Beuchat ◽  
...  
Keyword(s):  
Pediatric Trauma ◽  
Asymmetry Index ◽  
Complete Fusion ◽  
Trauma Patients ◽  
Anterior Fusion ◽  
Head Ct ◽  
Reported Study ◽  
The Mean ◽  
Suture Fusion ◽  
3D Volume

OBJECTIVESeveral years ago, the authors treated an infant with sagittal and bilateral parietomastoid suture fusion. This made them curious about the normal course of fusion of “minor” lateral sutures (sphenoparietal, squamosal, parietomastoid). Accordingly, they investigated fusion of these sutures on 3D volume-rendered head CT reconstructions in a series of pediatric trauma patients.METHODSThe authors reviewed all volume-rendered head CT reconstructions obtained from 2010 through mid-2012 at Children’s Hospital Colorado in trauma patients aged 0–21 years. Each sphenoparietal, squamosal, and parietomastoid suture was graded as open, partially fused, or fused. In several individuals, one or more lateral sutures were fused atypically. In these patients, the cephalic index (CI) and cranial vault asymmetry index (CVAI) were calculated. In a separately reported study utilizing the same reconstructions, 21 subjects had fusion of the sagittal suture. Minor lateral sutures were assessed, including these 21 individuals, excluding them, and considering them as a separate subgroup.RESULTSAfter exclusions, 331 scans were reviewed. Typically, the earliest length of the minor lateral sutures to begin fusion was the anterior squamosal suture, often by 2 years of age. The next suture to begin fusion—and first to complete it—was the sphenoparietal. The last suture to begin and complete fusion was the parietomastoid. Six subjects (1.8%) had posterior (without anterior) fusion of one or more squamosal sutures. Six subjects (1.8%) had fusion or near-complete fusion of one squamosal and/or parietomastoid suture when the corresponding opposite suture was open or nearly open. The mean CI and CVAI values in these subjects and in age- and sex-matched controls were normal and not significantly different. No individuals had a fused parietomastoid suture with open squamosal and/or sphenoparietal sutures.CONCLUSIONSFusion and partial fusion of the sphenoparietal, squamosal, and parietomastoid sutures is common in children and adolescents. It usually does not represent craniosynostosis and does not require cranial surgery. The anterior squamosal suture is often the earliest length of these sutures to fuse. Fusion then spreads anteriorly to the sphenoparietal suture and posteriorly to the parietomastoid. The sphenoparietal suture is generally the earliest minor lateral suture to complete fusion, and the parietomastoid is the last. Atypical patterns of fusion include posterior (without anterior) squamosal suture fusion and asymmetrical squamosal and/or parietomastoid suture fusion. However, these atypical fusion patterns may not lead to atypical head shapes or a need for surgery.

scholarly journals Fusion patterns of major calvarial sutures on volume-rendered CT reconstructions

2020 ◽  
Vol 25 (5) ◽  
pp. 519-528
Author(s):  
C. Corbett Wilkinson ◽  
Nicholas V. Stence ◽  
Cesar A. Serrano ◽  
Sarah J. Graber ◽  
Lígia Batista-Silverman ◽  
...  
Keyword(s):  
Pediatric Trauma ◽  
Complete Fusion ◽  
Trauma Patients ◽  
Sagittal Suture ◽  
Head Ct ◽  
Unknown Significance ◽  
Metopic Suture ◽  
The Mean ◽  
Suture Fusion ◽  
3D Volume

OBJECTIVERecently, the authors investigated the normal course of fusion of minor lateral calvarial sutures on “3D” volume-rendered head CT reconstructions in pediatric trauma patients. While evaluating these reconstructions, they found many more fused sagittal sutures than expected given the currently accepted prevalence of sagittal craniosynostosis. In the present study, using the same set of head CT reconstructions, they investigated the course of fusion of the sagittal as well as the lambdoid, coronal, and metopic sutures.METHODSThey reviewed all volume-rendered head CT reconstructions performed in the period from 2010 through mid-2012 at Children’s Hospital Colorado for trauma patients aged 0–21 years. Each sagittal, lambdoid, coronal, or metopic suture was graded as open, partially fused, or fused. The cephalic index (CI) was calculated for subjects with fused and partially fused sagittal sutures.RESULTSAfter exclusions, 331 scans were reviewed. Twenty-one subjects (6%) had fusion or partial fusion of the sagittal suture. Four of the 21 also had fusion of the medial lambdoid and/or coronal sutures. In the 17 subjects (5%) with sagittal suture fusion and no medial fusion of adjacent sutures, the mean CI was 77.6. None of the 21 subjects had been previously diagnosed with craniosynostosis. Other than in the 21 subjects already mentioned, no other sagittal or lambdoid sutures were fused at all. Nor were other coronal sutures fused medially. Coronal sutures were commonly fused inferiorly early during the 2nd decade of life, and fusion progressed superiorly and medially as subjects became older; none were completely fused by 18 years of age. Fusion of the metopic suture was first seen at 3 months of life; fusion was often not complete until after 2 years.CONCLUSIONSThe sagittal and lambdoid sutures do not usually begin to fuse before 18 years of age. However, more sagittal sutures are fused before age 18 than expected given the currently accepted prevalence of craniosynostosis. This finding is of unknown significance, but likely many of them do not need surgery. The coronal suture often begins to fuse inferiorly early in the 2nd decade of life but does not usually complete fusion before 18 years of age. The metopic suture often starts to fuse by 3 months of age, but it may not completely fuse until after 2 years of age.

scholarly journals Head CT Guidelines Following Concussion Among the Youngest Trauma Patients

2019 ◽  
Vol 11 (2) ◽  
pp. 38-43
Author(s):  
Bryan J. Harvell ◽  
Stephen D. Helmer ◽  
Jeanette G. Ward ◽  
Elizabeth Ablah ◽  
Raymond Grundmeyer ◽  
...  
Keyword(s):  
Skull Fracture ◽  
Pediatric Trauma ◽  
Altered Mental Status ◽  
Behavioral Changes ◽  
Neurosurgical Procedures ◽  
Trauma Patients ◽  
Clinical Indicators ◽  
Head Ct ◽  
Ct Findings ◽  
Basilar Skull Fracture

Introduction. Recent studies have provided guidelines on the use ofhead computed tomography (CT) scans in pediatric trauma patients.The purpose of this study was to identify the prevalence of theseguidelines among concussed pediatric patients. Methods. A retrospective review was conducted of patients fouryears or younger with a concussion from blunt trauma. Demographics,head injury characteristics, clinical indicators for head CT scan(severe mechanism, physical exam findings of basilar skull fracture,non-frontal scalp hematoma, Glasgow Coma Scale score, loss ofconsciousness, neurologic deficit, altered mental status, vomiting,headache, amnesia, irritability, behavioral changes, seizures, lethargy),CT results, and hospital course were collected. Results. One-hundred thirty-three patients (78.2%) received a headCT scan, 7 (5.3%) of which demonstrated fractures and/or bleeds. Allpatients with skull fractures and/or bleeds had at least one clinicalindicator present on arrival. Clinical indicators that were observedmore commonly in patients with positive CT findings than in thosewith negative CT findings included severe mechanism (100% vs.54.8%, respectively, p = 0.020) and signs of a basilar skull fracture(28.6% vs. 0.8%, respectively, p = 0.007). Severe mechanism alonewas found to be sensitive, but not specific, whereas signs of a basilarskull fracture, headache, behavioral changes, and vomiting were specific,but not sensitive. No neurosurgical procedures were necessary,and there were no deaths. Conclusions. Clinical indicators were present in patients with positiveand negative CT findings. However, severe mechanism of injuryand signs of basilar skull fracture were more common for patients withpositive CT findings. Kans J Med 2018;11(2):38-43.

Utility of STIR MRI in pediatric cervical spine clearance after trauma

2013 ◽  
Vol 12 (1) ◽  
pp. 30-36 ◽  
Author(s):  
Mark Henry ◽  
Katherine Scarlata ◽  
Ron I. Riesenburger ◽  
James Kryzanski ◽  
Leslie Rideout ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Predictive Value ◽  
Motor Vehicle ◽  
Motor Vehicle Accident ◽  
Pediatric Trauma ◽  
Outcome Data ◽  
Trauma Patients ◽  
Mri Studies ◽  
The Mean

Object Although MRI with short-term T1 inversion recovery (STIR) sequencing has been widely adopted in the clearance of cervical spine in adults who have sustained trauma, its applicability for cervical spine clearance in pediatric trauma patients remains unclear. The authors sought to review a Level 1 trauma center's experience using MRI for posttraumatic evaluation of the cervical spine in pediatric patients. Methods A pediatric trauma database was retrospectively queried for patients who received an injury warranting radiographic imaging of the cervical spine and had a STIR-MRI sequence of the cervical spine performed within 48 hours of injury between 2002 and 2011. Demographic, radiographic, and outcome data were retrospectively collected through medical records. Results Seventy-three cases were included in the analysis. The mean duration of follow-up was 10 months (range 4 days–7 years). The mean age of the patients at the time of trauma evaluation was 8.3 ± 5.8 years, and 65% were male. The majority of patients were involved in a motor vehicle accident. In 70 cases, the results of MRI studies were negative, and the patients were cleared prior to discharge with no clinical suggestion of instability on follow-up. In 3 cases, the MRI studies had abnormal findings; 2 of these 3 patients were cleared with dynamic radiographs during the same admission. Only 1 patient had an unstable injury and required surgical stabilization. The sensitivity of STIR MRI to detect cervical instability was 100% with a specificity of 97%. The positive predictive value was 33% and the negative predictive value was 100%. Conclusions Although interpretation of our results are diminished by limitations of the study, in our series, STIR MRI in routine screening for pediatric cervical trauma had a high sensitivity and slightly lower specificity, but may have utility in future practices and should be considered for implementation into protocols.

CLINICAL PARAMETERS AND ABNORMAL HEAD CT SCANS IN PEDIATRIC TRAUMA PATIENTS

1989 ◽  
Vol 5 (4) ◽  
pp. 288
Author(s):  
N. Schonfeld ◽  
J. Schunk ◽  
V. Lopez ◽  
C. Warden
Keyword(s):  
Pediatric Trauma ◽  
Ct Scans ◽  
Trauma Patients ◽  
Clinical Parameters ◽  
Head Ct ◽  
Abnormal Head

scholarly journals Prognostic predictors in polytraumatized children and their impact on outcome

2017 ◽  
Vol 4 (3) ◽  
pp. 1014 ◽  
Author(s):  
Ahmed Abdelhady Essa ◽  
Islam M. El-Shaboury ◽  
Mohammed A. Ibrahim ◽  
Emadeldien A. Abdelgwad ◽  
Mohammed A. Gadelrab
Keyword(s):  
Heart Rate ◽  
Respiratory Rate ◽  
Scoring System ◽  
Pediatric Patients ◽  
Pediatric Trauma ◽  
Morbidity And Mortality ◽  
Trauma Patients ◽  
Prognostic Predictors ◽  
Trauma Scoring ◽  
The Mean

Background: Trauma is the leading cause of death and disability in children ≥ 1 year of age. More than 80% of injuries are caused by blunt trauma. Most seriously injured children have multiple injuries. Injury scoring systems are designed to accurately assess injury severity, appropriately triage the injured, and develop and refine trauma patient care. The pediatric trauma scoring (PTS) was devised specifically for the triage of pediatric trauma patients. The pediatric trauma scoring (PTS) was devised specifically for the triage of pediatric trauma patients. The PTS is calculated as the sum of individual scores from six clinical variables. The variables include weight, airway, systolic blood pressure (SBP), central nervous system (CNS) status (level of consciousness), presence of an open wound, and skeletal injuries. Other predicting factors for morbidity and mortality in polytraumatised children include age and gender of the patients, trauma type, arrival interval time, Glasgow Coma Scale (GCS), respiratory rate, heart rate, hematocrit value at admission. These factors can further help to prevent mortality. The objectives of this study were to assess the prognosis of polytraumatised pediatric patients by evaluation of pediatric trauma scoring system and clinical predictors of morbidity and mortality as prognostic predictors of trauma in pediatric patients.Methods: This was adescriptive study, included 60 polytraumatised pediatric patients who were attended emergency department in Suez Canal University Hospital, Ismailia, Egypt.Results: This study showed that the mean of the pediatric trauma scoring system was 10±2. According to the nature of the most severe injury, this study showed that 43 % of injuries among patients were of extremities and pelvis nature. According to length of resuscitation time among patients, this study showed that the mean time of resuscitation was 35.5±8.23 minutes. According to the type of treatment done for the patients, this study showed that 72% of the patients didn't need surgical intervention. This study showed that regarding the final outcome of the patients, 68% of the patients were admitted to inpatient.Conclusions: This study showed that both heart rate and respiratory rate had good sensitivity while both of them had lower specificity. This study showed that GCS good specificity and fair sensitivity. Regarding the PTS, this study showed that PTS had the highest specificity and the highest sensitivity among all the predictors.

Utility of Neurosurgical Consultation for Mild Traumatic Brain Injury

2006 ◽  
Vol 72 (12) ◽  
pp. 1162-1167 ◽  
Author(s):  
Toan Huynh ◽  
David G. Jacobs ◽  
Stephanie Dix ◽  
Ronald F. Sing ◽  
William S. Miles ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Injury Severity ◽  
Ct Scans ◽  
Trauma Patients ◽  
Head Ct ◽  
Abnormal Head ◽  
The Mean ◽  
Gcs Score ◽  
Neurosurgical Intervention

Trauma patients presenting with a Glasgow Coma Scale (GCS) score of 14–15 are considered to have mild traumatic brain injury (TBI) with overall good neurologic outcomes. Current practice consists of initial stabilization, followed by a head CT, and neurosurgical consultation. Aside from serial neurologic examinations, patients with a GCS of 15 rarely require neurosurgical intervention. In this study, we examined the added value of neurosurgical consultation in the care of patients after TBI with a GCS of 15. We retrospectively reviewed the medical records of patients presenting after blunt trauma with an abnormal head CT and GCS of 15 between January 2004 and January 2005. Patients with a normal head CT and <48 hours hospital stay were excluded. Data included demographics, mechanisms of injury, Injury Severity Score, the radiologists’ dictated interpretations of the head CT, and neurosurgical interventions. Fifty-six patients met the inclusion criteria. The mean age was 41 ± 2.3 years, and the mean Injury Severity Scores was 10.2 ± 0.6. Mechanisms of injury included 64 per cent motor vehicle crash, 16 per cent motorcycle crash, 13 per cent fall, and 7 per cent all-terrain vehicle crash. The initial CT scans showed 43 per cent parenchymal contusions, 38 per cent subarachnoid hemorrhage, 14 per cent subdural hematomas, and 5 per cent epidural hematomas. All patients received a routine follow-up head CT, and 16 per cent showed changes (five improved and four were worse compared with initial CT scans). None of these patients received a neurosurgical intervention, and two were transferred to a rehabilitation service. In this era of limited resources, trauma patients who present with a GCS score of 15 after mild TBI can be safely managed without neurosurgical consultation, even in the presence of an abnormal head CT scan.

Pediatric Trauma Patients with Temporal Bone Fractures Are at Risk for Multiple Cranial CT Scans

2020 ◽  
Author(s):  
Joshua Ewy ◽  
Martin Piazza ◽  
Brian Thorp ◽  
Michael Phillips ◽  
Carolyn Quinsey
Keyword(s):  
At Risk ◽  
Temporal Bone ◽  
Bone Fractures ◽  
Pediatric Trauma ◽  
Ct Scans ◽  
Trauma Patients ◽  
Cranial Ct

The Frequency of Random Findings on Abdominal / Pelvis Computed Tomography in Pediatric Trauma Patients

2020 ◽  
Vol 16 ◽  
Author(s):  
Betül Tiryaki Baştuğ
Keyword(s):  
Computed Tomography ◽  
Incidental Findings ◽  
Pediatric Population ◽  
Pediatric Trauma ◽  
Trauma Patients ◽  
Injured Child ◽  
Level 3 ◽  
Male Patients ◽  
Clinically Significant ◽  
Discharge Summaries

Aims: In this study, we aimed to find the percentage of random pathologies and abdominopelvic region anomalies that are not related to trauma in pediatric patients. Background: An abdominal assessment of an injured child usually involves computed tomography imaging of the abdomen and pelvis (CTAP) to determine the presence and size of injuries. Imaging may accidentally reveal irrelevant findings. Objectives: Although the literature in adults has reviewed the frequency of discovering these random findings, few studies have been identified in the pediatric population. Methods: Data on 142( 38 female, 104 male) patients who underwent CTAP during their trauma evaluation between January 2019 and January 2020 dates were obtained from our level 3 pediatric trauma center trauma records. The records and CTAP images were examined retrospectively for extra traumatic pathologies and anomalies. Results: 67 patients (47%) had 81 incidental findings. There were 17 clinically significant random findings. No potential tumors were found in this population. Conclusion: Pediatric trauma CTAP reveals random findings. For further evaluation, incidental findings should be indicated in the discharge summaries.

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