Mild and moderate pediatric traumatic brain injury: Replace routine repeat head computed tomography with neurologic examination

Hassan Aziz, Peter M Rhee, Viraj Pandit, Irada Ibrahim-Zada, Narong Kulvatunyou, Julie Wynne, Bardiya Zangbar, Terence S Okeeffe, Andrew - Tang, Randall S Friese, Bellal A Joseph

Research output: Contribution to journalArticle

21 Citations (Scopus)

Abstract

BACKGROUND: Opinion is divided on the role of routine repeat head computed tomography (RHCT) for guiding clinical management in pediatric patients with blunt head trauma. We hypothesize that routine RHCT does not lead to change in management in mild and moderate traumatic brain injury (TBI). METHODS: This is a 3-year retrospective study of all patients of age 2 years to 18 years with blunt TBI admitted to our Level 1 trauma center with an abnormal head CT. Indications for RHCT (routine vs. neurologic deterioration) and their findings (progression or improvement) were recorded. Neurosurgical intervention was defined as extraventricular drain placement, craniectomy, or craniotomy. Primary outcome was a change in management after RHCT. RESULTS: A total of 291 pediatric patients were identified; of which 191 patients received an RHCT. Routine RHCT did not lead to neurosurgical intervention in the mild and moderate TBI group. In patients who received RHCT due to neurologic decline (n = 7), radiographic progression was seen on 85% of the patients (n = 6), with subsequent neurosurgical interventions in three patients. Two of these patients had a Glasgow Coma Scale (GCS) score of less than 8 at admission. CONCLUSION: Our study showed that the neurologic examination can be trusted and is reliable in pediatric blunt TBI patients in determining when an RHCT scan is necessary. We recommend that RHCT is required routinely in patients with intracranial hemorrhage with GCS score of 8 or less and in patients with GCS greater than 8 and that RHCT be performed only when there are clinical indications.

Original languageEnglish (US)
Pages (from-to)550-554
Number of pages5
JournalJournal of Trauma and Acute Care Surgery
Volume75
Issue number4
DOIs
StatePublished - Oct 2013

Fingerprint

Neurologic Examination
Head
Tomography
Pediatrics
Glasgow Coma Scale
Brain Concussion
Nervous System
Traumatic Brain Injury
Intracranial Hemorrhages
Craniotomy
Trauma Centers
Craniocerebral Trauma
Retrospective Studies

Keywords

  • neurological examination
  • neurosurgical intervention
  • Pediatric traumatic brain injury
  • progression on repeat head CT
  • repeat head CT

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine
  • Surgery

Cite this

Mild and moderate pediatric traumatic brain injury : Replace routine repeat head computed tomography with neurologic examination. / Aziz, Hassan; Rhee, Peter M; Pandit, Viraj; Ibrahim-Zada, Irada; Kulvatunyou, Narong; Wynne, Julie; Zangbar, Bardiya; Okeeffe, Terence S; Tang, Andrew -; Friese, Randall S; Joseph, Bellal A.

In: Journal of Trauma and Acute Care Surgery, Vol. 75, No. 4, 10.2013, p. 550-554.

Research output: Contribution to journalArticle

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abstract = "BACKGROUND: Opinion is divided on the role of routine repeat head computed tomography (RHCT) for guiding clinical management in pediatric patients with blunt head trauma. We hypothesize that routine RHCT does not lead to change in management in mild and moderate traumatic brain injury (TBI). METHODS: This is a 3-year retrospective study of all patients of age 2 years to 18 years with blunt TBI admitted to our Level 1 trauma center with an abnormal head CT. Indications for RHCT (routine vs. neurologic deterioration) and their findings (progression or improvement) were recorded. Neurosurgical intervention was defined as extraventricular drain placement, craniectomy, or craniotomy. Primary outcome was a change in management after RHCT. RESULTS: A total of 291 pediatric patients were identified; of which 191 patients received an RHCT. Routine RHCT did not lead to neurosurgical intervention in the mild and moderate TBI group. In patients who received RHCT due to neurologic decline (n = 7), radiographic progression was seen on 85{\%} of the patients (n = 6), with subsequent neurosurgical interventions in three patients. Two of these patients had a Glasgow Coma Scale (GCS) score of less than 8 at admission. CONCLUSION: Our study showed that the neurologic examination can be trusted and is reliable in pediatric blunt TBI patients in determining when an RHCT scan is necessary. We recommend that RHCT is required routinely in patients with intracranial hemorrhage with GCS score of 8 or less and in patients with GCS greater than 8 and that RHCT be performed only when there are clinical indications.",
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AU - Pandit, Viraj

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AU - Kulvatunyou, Narong

AU - Wynne, Julie

AU - Zangbar, Bardiya

AU - Okeeffe, Terence S

AU - Tang, Andrew -

AU - Friese, Randall S

AU - Joseph, Bellal A

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N2 - BACKGROUND: Opinion is divided on the role of routine repeat head computed tomography (RHCT) for guiding clinical management in pediatric patients with blunt head trauma. We hypothesize that routine RHCT does not lead to change in management in mild and moderate traumatic brain injury (TBI). METHODS: This is a 3-year retrospective study of all patients of age 2 years to 18 years with blunt TBI admitted to our Level 1 trauma center with an abnormal head CT. Indications for RHCT (routine vs. neurologic deterioration) and their findings (progression or improvement) were recorded. Neurosurgical intervention was defined as extraventricular drain placement, craniectomy, or craniotomy. Primary outcome was a change in management after RHCT. RESULTS: A total of 291 pediatric patients were identified; of which 191 patients received an RHCT. Routine RHCT did not lead to neurosurgical intervention in the mild and moderate TBI group. In patients who received RHCT due to neurologic decline (n = 7), radiographic progression was seen on 85% of the patients (n = 6), with subsequent neurosurgical interventions in three patients. Two of these patients had a Glasgow Coma Scale (GCS) score of less than 8 at admission. CONCLUSION: Our study showed that the neurologic examination can be trusted and is reliable in pediatric blunt TBI patients in determining when an RHCT scan is necessary. We recommend that RHCT is required routinely in patients with intracranial hemorrhage with GCS score of 8 or less and in patients with GCS greater than 8 and that RHCT be performed only when there are clinical indications.

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