Skip to main content
SpringerLink
Log in

Diagnostic approach to children with minor traumatic brain injury

Diagnostisches Vorgehen bei Kindern mit leichtem Schädelhirntrauma

  • original article
  • Published:
Wiener Medizinische Wochenschrift Aims and scope Submit manuscript

Summary

Study purpose

To analyse the management of minor traumatic brain injury (MTBI) in paediatric hospitals in Germany.

Methods

An electronic survey was sent to 72 children hospitals.

Results

All participating (45/72; 62.5 %) hospitals had facilities to perform an electroencephalogram (EEG), 98 % cranial ultrasonography, 94 % MRI studies, and 87 % a CT scan. The initial Glasgow Coma Scale, the clinical presentation/neurological deficits, the intensity of the trauma and external/visible injuries were most important for initial assessment. The main reason for in-patient monitoring was initial clinical neurologic presentation (44 %). X-ray scans were used routinely in only 2.2 %, cMRI scans in 6.7 % and cCT scans in 13.3 %; approximately one third employed ultrasonography. In 22.2 % was an EEG part of the routine diagnostic work-up. Inpatient monitoring for 24–48 h was done in 80 %.

Conclusions

Children with MTBI are often monitored clinically without resorting to potentially harmful and expensive diagnostic procedures (cCT scans).

Zusammenfassung

Grundlagen

Das diagnostische Vorgehen bei Kindern mit leichtem Schädeltrauma (MTBI) variiert erheblich. Ziel dieser Untersuchung war es, aktuelle Daten zum diagnostischen Vorgehen bei Kindern mit MTBI in Deutschland zu erheben.

Methodik

Wir versandten einen elektronischen Fragebogen an 72 repräsentative Kinderkliniken in Deutschland.

Ergebnisse

Die Rücklaufquote betrug 45/72 (62,5 %). Alle teilnehmenden Kliniken hatten die Möglichkeit, eine EEG-Untersuchung (100 %), 98 % eine cerebrale Ultraschalluntersuchung, 94 % eine cMRT-Untersuchung und 87 % eine cCT durchzuführen. Vierzig Prozent der Kliniken benutzen die Glasgow Coma Skala (GCS), die klinisch-neurologische Symptomatik, die Schwere des Traumas und äußerlich erkennbare Verletzungen zur initialen Einschätzung des SHT. Der wichtigste singuläre Grund zur stationären Aufnahme/Überwachung war der initiale neurologische Status (44%). Routinemäßige Röntgenuntersuchungen wurden nur sehr selten durchgeführt (2,2 %); cMRT-Untersuchungen in 6,7 % und eine cCT in 13,3 %; rund ein Drittel der Krankenhäuser verwendeten die Ultrasonografie. Die Durchführung einer routinemäßigen EEG-Untersuchung wurde in 22,2 % der Kliniken durchgeführt. Achtzig Prozent der Kliniken beobachteten die Kinder für einen Zeitraum von 24 bis 48 h; insbesondere Säuglinge (Alter < 6 Monate) wurden häufiger mindestens 48 h stationär beobachtet.

Schlussfolgerungen

Unsere Untersuchung liefert aktuelle Daten zum diagnostischen Vorgehen bei Kindern mit MTBI. Kinder mit MTBI werden meist stationär klinisch überwacht, häufig ohne weitere, z. T., sehr aufwändige diagnostische, bildgebende Verfahren zu verwenden. Der Einsatz der Elektrophysiologie (EEG) beim MTBI im Kindesalter ist relativ selten und dient meist der Detektion von epilepsietypischen Potenzialen.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Babikian T, Satz P, Zaucha K, Light R, Lewis RS, Asarnow RF. The UCLA longitudinal study of neurocognitive outcomes following mild pediatric traumatic brain injury. J Int Neuropsychol Soc. 2011;4:1–10.

    Google Scholar 

  2. Holmes JF, Borgialli DA, Nadel FM, Quayle KS, Schambam N, Cooper A, Schunk JE, Miskin ML, Atabaki SM, Hoyle JD, Dayan PS, Kuppermann N. TBI Study Group for the Pediatric Emergency Care Applied Research Network* Do children with blunt head trauma and normal cranial computed tomography scan results require hospitalization for neurologic observation? Ann Emerg Med. 2011 Jun 15. [Epub ahead of print]

  3. http://www.awmf.org/uploads/tx_szleitlinien/006-121.pdf. Accessed 30 Dec 2011

  4. Jacobson M, Sperling MR. The electroencephalogram in minor brain injury. In Mandel S, Sataloff RT, Schapiro SR, editors. Minor head trauma: assessment, management, and rehabilitation. New York: Springer-Verlag; 1993

    Google Scholar 

  5. Langlois JA, Rutland-Brown W, Thomas KE, Xi YL. Traumatic brain injury in the United States, 2003. J Head Trauma Rehabil. 2006;216:544–8.

    Google Scholar 

  6. Meyer S, Gottschling S, Baghai A, Polcher T, Strittmatter M, Gortner L. The role of S100B-protein in neonatology, pediatric intensive care, and pediatrics. Klin Padiatr. 2006;218:49–56.

    Article  PubMed  CAS  Google Scholar 

  7. Berger RP, Kochanek PM. Urinary S100B concentrations are increased after brain injury in children: a preliminary study. Pediatr Crit Care Med. 2006;7:557–61.

    Article  PubMed  Google Scholar 

  8. Topolovec-Vranic J, Pollmann-Mudryj MA, Ouchterlony D, Klein D, Spence J, Romaschin A, Rhind S, Tien HC, Baker AJ. The value of serum biomarkers in prediction models of outcome after mild traumatic brain injury. J Trauma. 2011;71(5 Suppl 1):S.478–86.

    Article  Google Scholar 

  9. Oman JA, Cooper RJ, Holmes JF, Viccellio P, Nyce A, Ross SE, Hoffman JR, Mower WR. NEXUS II Investigators. performance of a decision rule to predict need for computed tomography among children with blunt head trauma. Pediatrics. 2006;117:e238–46.

    Article  PubMed  Google Scholar 

  10. Oster I, Shamdeen GM, Gottschling S, Gortner L, Meyer S. Electroencephalogram in children with minor traumatic brain injury. J Paediatr Child Health. 2010;46:373–7.

    Article  PubMed  Google Scholar 

  11. Palchak MJ, Holmes JF, Vance CW, Gelber RE, Schauer BA, Harrison MJ, Willis-Shore J, Wootton-Gorges SL, Derlet RW, Kuppermann. A decision rule for identifying children at low risk for brain injuries after blunt head trauma. Ann Emerg Med. 2003;42:492–506.

    Article  PubMed  Google Scholar 

  12. Quayle KS, Jaffe DM, Kuppermann N, Kaufman BA, Lee BC, Park TS, McAlister WH. Diagnostic testing for acute head injury in children: when are head computed tomography and skull radiographs indicated? Pediatrics. 1997;99:E11.

    Article  PubMed  CAS  Google Scholar 

  13. Sharpe S, Kool B, Shepherd M, Dalziel S, Ameratunga S. Mild traumatic brain injury: improving quality of care in the paediatric emergency department setting. J Paediatr Child Health. 2011 Apr 7. doi: 10.1111/j.1440–1754.2011.02068.x.

  14. Stiell IG, Lesiuk H, Wells GA, Coyle D, McKnight RD, Brison R, Clement C, Eisenhauer MA, Greenberg GH, Macphail I, Reardon M, Worthington J, Verbeek R, Rowe B, Cass D, Dreyer J, Holroyd B, Morrison L, Schull M, Laupacis A; Canadian CT Head and C-Spine Study Group (2001) The Canadian CT head rule study for patients with minor head injury: rationale, objectives, and methodology for phase I (derivation). Ann Emerg Med. 2001;38:160–9.

    Article  PubMed  CAS  Google Scholar 

  15. von Wild K, Terwey S. Diagnostic confusion in mild traumatic brain injury (MTBI). Lessons from clinical practice and EFNS-inquiry. European Federation of Neurological Societies. Brain Inj. 2001;15:273–7.

    Article  PubMed  CAS  Google Scholar 

  16. Vos PE, Battistin L, Birbamer G, Gerstenbrand F, Potapov A, Prevec T, Stepan ChA, Traubner P, Twijnstra A, Vecsei L, von Wild K; European Federation of Neurological Societies. EFNS guideline on mild traumatic brain injury: report of an EFNS task force. Eur J Neurol. 2002;9:207–19.

    Article  PubMed  CAS  Google Scholar 

  17. Yeates KO, Taylor HG, Rusin J, Bangert B, Dietrich A, Nuss K, Wright M. Premorbid child and family functioning as predictors of post-concussive symptoms in children with mild traumatic brain injuries. Int J Dev Neurosci. 2011 May 27. [Epub ahead of print]

Download references

Conflict of interest

The authors state that no conflict of interests is involved with this work.

Author information

Authors and Affiliations

  1. Department of Pediatric Intensive care Medicine, Neurotology and Neuropediatrics, University Children’s Hospital of Saarland, Building 9, 66421, Homburg, Germany

    Ludwig Gortner MD

  2. Department of Neuroradiology, University Children’s Hospital of Saarland, Homburg, Germany

    Karin Ziegler MD

  3. Department of Neurosurgery, University Children’s Hospital of Saarland, Homburg, Germany

    Regina Eymann MD

  4. Department of Pediatric Intensive Care Medicine, Neonatology, and Neuropediatrics, University Hospital of Saarland, Homburg, Germany

    Ludwig Gortner MD &  Sascha Meyer MD

  5. Section Neuropediatrics, University Children’s Hospital of Saarland, Homburg, Germany

    Isabel Oster MD, Ghiath M. Shamdeen MD &  Sascha Meyer MD

Authors
  1. Isabel Oster MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ghiath M. Shamdeen MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Karin Ziegler MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Regina Eymann MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ludwig Gortner MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Sascha Meyer MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sascha Meyer MD.

Additional information

Isabel Oster and Sascha Meyer contributed equally to this work.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Oster, I., Shamdeen, G., Ziegler, K. et al. Diagnostic approach to children with minor traumatic brain injury. Wien Med Wochenschr 162, 394–399 (2012). https://doi.org/10.1007/s10354-012-0124-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10354-012-0124-x

Keywords

Schlüsselwörter

Search

Navigation