DOI: http://dx.doi.org/10.18203/2349-3291.ijcp20184256

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

Karthick Jayapal, Hassan Adnan Mansour

Abstract


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.


Keywords


Computed tomography, Glasgow coma scale, Hematoma, Pediatric emergency, Traumatic brain injury

Full Text:

PDF

References


Mahapatra AK, Kumar R. Pediatric Head injury. In: Mahapatra AK, Kumar R, Kamal R, editors. Textbook of traumatic brain injury. 1st edition. Jaypee Brothers Medical Publishers Private Limited. 2012:180-90.

Satapathy MC, Dash D, Mishra SS, Tripathy SR, Nath PC, Jena SP. Spectrum and outcome of traumatic brain injury in children <15 years: a tertiary level experience in India. Int J Critical Illness Injury Sci. 2016;6(1):16-20.

Larson DB, Johnson LW, Schnell BM. Rising use of CT in child visits to the emergency department in the United States. Radiol. 2011;259:793-801.

Quayle KS, Powell EC, Mahajan P. Epidemiology of blunt head trauma in children in U.S. emergency departments. N Engl J Med. 2014;371(20):1945-7.

Linscott LL, Kessler MM, Kitchin DR, Quayle KS, Hildebolt CF, McKinstry RC, Don S. CT for pediatric, acute, minor head trauma: clinician conformity to published guidelines. Am J Neuroradiol. 2013;34(6):125.

Homme JL. Pediatric Minor Head Injury 2.0 Moving from injury exclusion to risk stratification. Emerg Med Clin N Am. 2018;36:287-304.

Easter JS, Bakes K, Dhaliwal J. Comparison of PECARN, CATCH, and CHALICE rules for children with minor head injury: a prospective cohort study. Ann Emerg Med. 2014;64(2):145-52.

Gelernter R, Weiser G, Kozer E. Computed tomography findings in young children with minor head injury presenting to the emergency department greater than 24 hours post injury. Injury Int J Care Injured. 2018;49:82-5.

Mandera M, Wencel T, Ba┼╝owski P, Krauze J. How should we manage children after mild head injury? Child's Nervous System. 2000;16(3):156-60.

Hamilton M, Mrazik M, Johnson DW. Incidence of delayed intracranial hemorrhage in children after uncomplicated minor head injuries. Pediatr. 2010;126:e33-9.

The L. The burden of traumatic brain injury in children. Lance. 2018;391(10123):813.

Rosen CB, Luy DD, Deane MR, Scalea TM, Stein DM. Routine repeat head CT may not be necessary for patients with mild TBI. Trauma Surgery Acute Care Open. 2018;3(1):e000129.

Pang D. Pathophysiologic correlates of neurobehavioral syndromes following closed head injury. In Ylvisaker M, ed. Head Injury Rehabilitation: Children and Adolescents. London: Taylor and Francis; 1985:3-70.

Hawe RL, Sukal-Moulton T, Dewald JPA. The effect of injury timing on white matter changes in the corpus callosum following unilateral brain injury. Neuroimage Clinical. 2013;3:115-22.

Andrade FP, Neto RM, Oliveria R, Loures G, Gross R, Donnabella C. Pediatric minor head trauma: Do cranial CT scans change the therapeutic approach? Clin. 2016;71(10):606-10.