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Brain CT scan for pediatric minor accidental head injury. An Italian experience and review of literature

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Abstract

Purpose

Every year 300,000 children with accidental head trauma are admitted to Italian emergency departments. Our aims were: (1) to describe patients with minor traumatic brain injury who were admitted to pediatric departments and underwent CT, and (2) to analyze the appropriateness of management according to current guidelines.

Methods

We retrospectively analyzed patients with minor head injury (median age 4.5 years, range 1 month to 16 years) who were admitted to the pediatric department of the Catholic Medical School of Rome, from January 2005 to September 2010, who performed head CT. Univariate analysis was performed using the Fisher’s exact test. Multivariate analysis was performed by logistic regression.

Results

One hundred and seventy-four patients were enrolled in the study. Fifty-four patients (31%) had pathological CT findings. Eight patients underwent neurosurgical treatments. Vomiting was the only symptom significantly prevalent in the infant group, compared to the children group (10.7% vs. 38.9%, p = 0.007), while loss of consciousness in the children group (50.0% vs. 25.0%, p = 0.040). The relationship between scalp swelling and CT abnormalities was statistically significant in the entire population. The incidence of head abnormalities was significantly higher in children with abnormal CT (92.6% vs. 72.5%).

Conclusions

The best way to manage children with minor head trauma is still matter of debate. Loss of consciousness and scalp swelling are risk factors predicting brain injury that deserve CT control. The radiation risks posed by CT scanning in children must be balanced by the benefits. We believe that even though CT scans may be clinically unnecessary in many cases, the rate of scanning is justified by the even limited number of abnormalities which require neurosurgical treatment.

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References

  1. ISTAT (Italian National Institute of Statistics) 2000 (2004) Cause di morte (Causes of death). http://www.istat.it/Prodotti-e/Allegati1/Cause-di-m6/volumeII.pdf. Accessed 18 October

  2. Bishop NB (2006) Traumatic brain injury: a primer for primary care physicians. Curr Probl Pediatr Adolesc Health Care 36:318–31

    Article  PubMed  Google Scholar 

  3. National Collaborating Centre for Acute Care (UK) (2007) Head Injury: Triage, Assessment, Investigation and Early Management of Head Injury in Infants, Children and Adults. London: National Collaborating Centre for Acute Care (UK)

  4. Da Dalt L, Marchi AG, Laudizi L, Crichiutti G, Messi G, Pavanello L, Valent F, Barbone F (2006) Predictors of intracranial injuries in children after blunt head trauma. Eur J Ped 165:142–8

    Article  Google Scholar 

  5. Stein SC, Fabbri A, Servadei F et al (2009) A critical comparison of clinical decision instruments for computed tomographic scanning in mild closed traumatic brain injury in adolescents and adults. Ann Emerg Med 53:180–8

    Article  PubMed  Google Scholar 

  6. Stiell IG, Wells GA, Vandemheen K et al (2001) The Canadian CT head rule for patients with minor head injury. Lancet 3(57):1391–6

    Article  Google Scholar 

  7. SIGN (2009) Early management of patients with a head injury. A national clinical guideline. http://www.sign.ac.uk/pdf/sign110.pdf. Accessed Dec 2011

  8. SIAARTI-SARNePI (2004) Guidelines for the management of severe pediatric head injury. Minerva Anestesiol 70:549–604

    Google Scholar 

  9. Dunning J, Daly JP, Lomas J-P, Batchelor J (2006) Derivation of the children’s head injury algorithm for the prediction of important clinical events decision rule for head injury in children. Arch Dis Child 91:885–91

    Article  PubMed  CAS  Google Scholar 

  10. Osmond MH, Klassen TP, Wells GA, Correll R, Jarvis A, Joubert G, Bailey B, Chauvin-Kimoff L, Pusic M, McConnell D, Nijssen-Jordan C, Silver N, Taylor B, Stiell IG; Pediatric Emergency Research Canada (PERC) Head Injury Study Group. CATCH: a clinical decision rule for the use of computed tomography in children with minor head injury. CMAJ. 2010 Mar 9;182(4):341-8. Epub 2010 Feb 8.

    Article  PubMed  Google Scholar 

  11. Klemetti S, Uhari M, Pokka T, Rantala H (2009) Evaluation of decision rules for identifying serious consequences of traumatic head injuries in pediatric patient. Pediatr Emerg Care 25(12):811–5

    Article  PubMed  Google Scholar 

  12. American Academy of Pediatrics (1999) The management of minor closed head injury in children. Pediatrics 104:1407–15

    Article  Google Scholar 

  13. National Center for Injury Prevention and Control (2008) Traumatic brain injury. Atlanta: Centers for Disease Control and Prevention. http://www.cdc.gov/ncipc/tbi/TBI.htm. Accessed 17 April 2008

  14. The Italian Office of the Health, the Italian institute of Statistic (ISTAT) (1999). Incidence of head injury by age segment of Italian population year. http://www.istat.it/. Accessed Dec 2011

  15. Güzel A, Hiçdönmez T, Temizöz O, Aksu B, Aylanç H, Karasalihoglu S (2009) Indications for brain computed tomography and hospital admission pediatric patients with minor head injury: how much can we rely upon clinical findings? Pediatr Neurosurg 45:262–70

    Article  PubMed  Google Scholar 

  16. Berry J, Jamieson L, Harrison E (2010) Head traumatic brain injuries among Australian children, July 2000–June 2006. Inj Prev 16(3):198–202

    Article  PubMed  Google Scholar 

  17. D’Ippolito A, Collins CL, Comstock RD (2010) Epidemiology of pediatric holiday-related injuries presenting to US emergency departments. Pediatrics 125(5):931–7

    Article  PubMed  Google Scholar 

  18. Love PF, Tepas JJ III, Wludyka PS, Masnita-Iusan C (2009) Fall-related pediatric brain injuries: the role of race, age, and sex. J Trauma 67:S12–5

    Article  PubMed  Google Scholar 

  19. Tufano R, Di Rocco C (2004) Severely head-injured children: treatment and dilemma. Minerva Anestesiol 70(7–8):545–7

    PubMed  CAS  Google Scholar 

  20. Kuppermann N, Holmes JF, Dayan PS, Pediatric Emergency Care Applied Research Network (PECARN) et al (2009) Identification of children at very low risk of clinically-important brain injuries after head trauma: a prospective cohort study. Lancet 374(9696):1160–70

    Article  PubMed  Google Scholar 

  21. Atabaki SM, Stiell IG, Bazarian JJ et al (2008) A clinical decision rule for cranial computed tomography in minor pediatric head trauma. Arch Pediatr Adolesc Med 162:439–45

    Article  PubMed  Google Scholar 

  22. Palchak MJ, Holmes JF, Vance CW et al (2003) A decision rule for identifying children at low risk for brain injuries after blunt head trauma. Ann Emerg Med 42:492–506

    Article  PubMed  Google Scholar 

  23. Maguire JL, Boutis K, Uleryk EM et al (2009) Should a head-injured child receive a head CT scan? A systematic review of clinical prediction rules. Pediatrics 124:e145–54

    Article  PubMed  Google Scholar 

  24. Homer CJ, Kleinman L (2003) Technical report: minor head injury in children. Pediatrics 104:1–7

    Google Scholar 

  25. Abdel-Dayem HM, Abu-Judeh H, Kumar M et al (1998) SPECT brain perfusion abnormalities in mild or moderate traumatic brain injury. Clin Nucl Med 23:309–17

    Article  PubMed  CAS  Google Scholar 

  26. Haydel MJ, Shembekar AD (2003) Prediction of intracranial injury in children aged five years and older with loss of consciousness after minor head injury due to non trivial mechanisms. Ann Emerg Med 42:507–14

    Article  PubMed  Google Scholar 

  27. Schutzman SA, Greenes DS (2001) Pediatric minor head trauma. Ann Emerg Med 37:65–74

    Article  PubMed  CAS  Google Scholar 

  28. Ando S, Otani M, Moritake K (1992) Clinical analysis of post traumatic vomiting. Acta Neurochir 119:97–100

    Article  CAS  Google Scholar 

  29. Brown FD, Brown J, Beattie TF (2000) Why do children vomit after minor head injury? J Accid Emerg Med 17(4):268–71

    Article  PubMed  CAS  Google Scholar 

  30. Jan MMS, Camfield PR, Gordon K et al (1997) Vomiting after mild head injury is related to migraine. J Pediatr 130:134–7

    Article  PubMed  CAS  Google Scholar 

  31. Carpenter DO (1990) Neural mechanism of emesis. Can J Physiol Pharmacol 68:230–6

    Article  PubMed  CAS  Google Scholar 

  32. Brenner DJ (2002) Estimating cancer risks from pediatric CT: going from the qualitative to the quantitative. Pediatr Radiol 32:228–31

    Article  PubMed  Google Scholar 

  33. Hoffman GM, Nowakowski R, Troshynski TJ, Berens RJ, Weisman SJ (2002) Risk reduction in pediatric procedural sedation by application of an American Academy of Pediatrics/American Society of Anesthesiologists process model. Pediatrics 109(2):236–43

    Article  PubMed  Google Scholar 

  34. Mazonakis M, Tzedakis A, Damilakis J et al (2007) Thyroid dose from common head and neck CT examinations in children: is there an excess risk for thyroid cancer induction? Eur Radiol 17:1352–7

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Pediatrics, Catholic University of Rome, Rome, Italy

    C. Fundarò, S. Monaco, F. Cota, V. Giorgio, S. Filoni & R. Onesimo

  2. Department of Neurosurgery, Catholic University of Rome, Rome, Italy

    M. Caldarelli & C. Di Rocco

  3. Department of Pediatrics, Catholic University of Sacred Heart, L. go Gemelli 8, 00168, Rome, Italy

    R. Onesimo

Authors
  1. C. Fundarò
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  2. M. Caldarelli
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  3. S. Monaco
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  4. F. Cota
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  5. V. Giorgio
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  6. S. Filoni
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  7. C. Di Rocco
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  8. R. Onesimo
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Correspondence to R. Onesimo.

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Fundarò, C., Caldarelli, M., Monaco, S. et al. Brain CT scan for pediatric minor accidental head injury. An Italian experience and review of literature. Childs Nerv Syst 28, 1063–1068 (2012). https://doi.org/10.1007/s00381-012-1717-9

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  • DOI: https://doi.org/10.1007/s00381-012-1717-9

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