TY - JOUR
T1 - Are serial brain imaging scans required for children who have suffered acute intracranial injury secondary to blunt head trauma?
AU - Schnellinger, Mark G.
AU - Reid, Samuel
AU - Louie, Jeff
PY - 2010/6
Y1 - 2010/6
N2 - In most instances, infants and children with moderate to severe head trauma undergo a head computed tomography (CT) scan as part of their initial evaluation. Several authors have advocated a routine second head CT after traumatic brain injury (TBI) to identify progressive lesions that may require surgical intervention. However, recent studies have challenged the need for a routine second brain imaging study after TBI. In addition, recent reports have raised concerns about the potential for malignancy following CT scanning, especially in pediatric patients. The authors performed a retrospective case series of all patients, aged 0 to 21 years, who presented to their 2 emergency departments (EDs) and received an International Classification of Disease-9th revision code related to intracranial injury. Out of 47 children, 5 (11%) underwent neurosurgical intervention following their second imaging study, and 1 of these interventions was unplanned after the first study. Compared with children who did not require an intervention following their second scan, children who received an intervention were more likely to have been subjected to nonaccidental trauma and to have presented to the ED more than 4 hours after the injury. Most children with intracranial injury following blunt trauma who did not require immediate neurosurgical intervention but instead underwent a follow-up brain imaging study did not require subsequent unplanned neurosurgical intervention. Serial brain imaging may not be required for all children with intracranial injury.
AB - In most instances, infants and children with moderate to severe head trauma undergo a head computed tomography (CT) scan as part of their initial evaluation. Several authors have advocated a routine second head CT after traumatic brain injury (TBI) to identify progressive lesions that may require surgical intervention. However, recent studies have challenged the need for a routine second brain imaging study after TBI. In addition, recent reports have raised concerns about the potential for malignancy following CT scanning, especially in pediatric patients. The authors performed a retrospective case series of all patients, aged 0 to 21 years, who presented to their 2 emergency departments (EDs) and received an International Classification of Disease-9th revision code related to intracranial injury. Out of 47 children, 5 (11%) underwent neurosurgical intervention following their second imaging study, and 1 of these interventions was unplanned after the first study. Compared with children who did not require an intervention following their second scan, children who received an intervention were more likely to have been subjected to nonaccidental trauma and to have presented to the ED more than 4 hours after the injury. Most children with intracranial injury following blunt trauma who did not require immediate neurosurgical intervention but instead underwent a follow-up brain imaging study did not require subsequent unplanned neurosurgical intervention. Serial brain imaging may not be required for all children with intracranial injury.
KW - Computed tomography
KW - Emergency department
KW - International Classification of Disease-9th revision
KW - Intracranial hemorrhage
KW - Magnetic resonance imaging
KW - Traumatic brain injury
UR - http://www.scopus.com/inward/record.url?scp=77953018159&partnerID=8YFLogxK
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U2 - 10.1177/0009922809352375
DO - 10.1177/0009922809352375
M3 - Article
C2 - 20118091
AN - SCOPUS:77953018159
SN - 0009-9228
VL - 49
SP - 569
EP - 573
JO - Clinical Pediatrics
JF - Clinical Pediatrics
IS - 6
ER -