PDF(Pubmed)
Abstract：
BACKGROUND: Head trauma is a leading cause of death and disability. While standard treatment protocols exist for severe head trauma, no clear follow-up standards are available for mild head trauma with positive imaging findings in infants and newborns. Although routine follow-up brain computed tomography (CT) imaging is not recommended for children with moderate and mild head trauma, the necessity for follow-up imaging in infants and newborns remains uncertain.
METHODS: Our study is a retrospective, observational, and descriptive study. Infants under 1 year old presenting to the emergency department with isolated head trauma were reviewed with the approval of the Ethics Committee of Ankara Etlik City Hospital. Inclusion criteria included presentation to the emergency department, undergoing more than one brain CT scan, and sustaining mild head trauma (Glasgow Coma Scale [GCS] >13). Patients with incomplete follow-up data or multiple traumas were excluded. Age, gender, mechanism of trauma, initial and follow-up brain CT findings, hospital admission, and surgical procedures were recorded and analyzed using the SPSS statistical package.
RESULTS: Out of 238 screened patients, 154 were included in the study. Of these, 66.9% were male and the average age was 5.99 months. The most common presenting symptom was swelling at the trauma site, observed in 79.2% of cases. The most common mechanism of injury was falling from a height of less than 90 cm, accounting for 85.1% of cases. Pathological progression on follow-up CT was observed in 5.2% of the patients, and only 1.9% required surgical treatment. A total of 34.4% of the patients required hospitalization. Patients with parenchymal brain pathology had a higher rate of pathological progression on follow-up CT and a longer hospital stay.
CONCLUSIONS: Follow-up CT scans in infants with mild head trauma do not alter patient outcomes except in cases with brain parenchymal pathology. Study data indicated that repeat imaging is not beneficial for isolated skull fractures. Imaging artifacts often necessitated repeated scans, contributing to increased radiation exposure. Unnecessary repeat imaging escalates radiation exposure and healthcare costs. Only a small percentage of patients exhibited progression of intracranial pathology, justifying follow-up imaging solely in the presence of brain parenchymal injury. Larger prospective studies are necessary to confirm these findings.
METHODS: Our study is a retrospective, observational, and descriptive study. Infants under 1 year old presenting to the emergency department with isolated head trauma were reviewed with the approval of the Ethics Committee of Ankara Etlik City Hospital. Inclusion criteria included presentation to the emergency department, undergoing more than one brain CT scan, and sustaining mild head trauma (Glasgow Coma Scale [GCS] >13). Patients with incomplete follow-up data or multiple traumas were excluded. Age, gender, mechanism of trauma, initial and follow-up brain CT findings, hospital admission, and surgical procedures were recorded and analyzed using the SPSS statistical package.
RESULTS: Out of 238 screened patients, 154 were included in the study. Of these, 66.9% were male and the average age was 5.99 months. The most common presenting symptom was swelling at the trauma site, observed in 79.2% of cases. The most common mechanism of injury was falling from a height of less than 90 cm, accounting for 85.1% of cases. Pathological progression on follow-up CT was observed in 5.2% of the patients, and only 1.9% required surgical treatment. A total of 34.4% of the patients required hospitalization. Patients with parenchymal brain pathology had a higher rate of pathological progression on follow-up CT and a longer hospital stay.
CONCLUSIONS: Follow-up CT scans in infants with mild head trauma do not alter patient outcomes except in cases with brain parenchymal pathology. Study data indicated that repeat imaging is not beneficial for isolated skull fractures. Imaging artifacts often necessitated repeated scans, contributing to increased radiation exposure. Unnecessary repeat imaging escalates radiation exposure and healthcare costs. Only a small percentage of patients exhibited progression of intracranial pathology, justifying follow-up imaging solely in the presence of brain parenchymal injury. Larger prospective studies are necessary to confirm these findings.
摘要：
背景：头部外伤是导致死亡和残疾的主要原因。虽然存在严重头部创伤的标准治疗方案，对于婴儿和新生儿影像学检查结果阳性的轻度头部外伤,目前尚无明确的随访标准.尽管不建议对中度和轻度头部外伤的儿童进行常规随访脑计算机断层扫描（CT）成像，对婴儿和新生儿进行随访成像的必要性仍不确定.
方法：我们的研究是回顾性的，观察,和描述性研究。在安卡拉Etlik市医院伦理委员会的批准下，对1岁以下的因孤立性头部创伤而到急诊科就诊的婴儿进行了审查。纳入标准包括向急诊科介绍，接受了不止一次脑部CT扫描,并维持轻度头部创伤(格拉斯哥昏迷评分[GCS]>13)。排除随访数据不完整或多发创伤的患者。年龄,性别,创伤的机制，初步和后续脑CT检查结果，入院,使用SPSS统计软件包记录和分析手术程序。
结果：在238名筛查患者中，154人被纳入研究。其中,男性占66.9%，平均年龄5.99个月。最常见的症状是创伤部位肿胀，在79.2%的病例中观察到。最常见的损伤机制是从不到90厘米的高度坠落，占病例的85.1%。5.2％的患者在随访CT上观察到病理进展，只有1.9%需要手术治疗。总共有34.4％的患者需要住院治疗。脑实质病理的患者在随访CT时病理进展率较高，住院时间较长。
结论：轻度颅脑外伤婴儿的后续CT扫描不会改变患者的预后，除了脑实质病理学的病例。研究数据表明，重复成像对孤立的颅骨骨折没有好处。成像伪影通常需要重复扫描，有助于增加辐射暴露。不必要的重复成像增加了辐射暴露和医疗保健成本。只有一小部分患者表现出颅内病理进展，仅在存在脑实质损伤的情况下证明随访成像是合理的。需要更大规模的前瞻性研究来证实这些发现。
方法：我们的研究是回顾性的，观察,和描述性研究。在安卡拉Etlik市医院伦理委员会的批准下，对1岁以下的因孤立性头部创伤而到急诊科就诊的婴儿进行了审查。纳入标准包括向急诊科介绍，接受了不止一次脑部CT扫描,并维持轻度头部创伤(格拉斯哥昏迷评分[GCS]>13)。排除随访数据不完整或多发创伤的患者。年龄,性别,创伤的机制，初步和后续脑CT检查结果，入院,使用SPSS统计软件包记录和分析手术程序。
结果：在238名筛查患者中，154人被纳入研究。其中,男性占66.9%，平均年龄5.99个月。最常见的症状是创伤部位肿胀，在79.2%的病例中观察到。最常见的损伤机制是从不到90厘米的高度坠落，占病例的85.1%。5.2％的患者在随访CT上观察到病理进展，只有1.9%需要手术治疗。总共有34.4％的患者需要住院治疗。脑实质病理的患者在随访CT时病理进展率较高，住院时间较长。
结论：轻度颅脑外伤婴儿的后续CT扫描不会改变患者的预后，除了脑实质病理学的病例。研究数据表明，重复成像对孤立的颅骨骨折没有好处。成像伪影通常需要重复扫描，有助于增加辐射暴露。不必要的重复成像增加了辐射暴露和医疗保健成本。只有一小部分患者表现出颅内病理进展，仅在存在脑实质损伤的情况下证明随访成像是合理的。需要更大规模的前瞻性研究来证实这些发现。
