Durham Susan R, Liu Kenneth C, Selden Nathan R
Department of Neurological Surgery, Division of Pediatric Neurosurgery, Doernbecher Children's Hospital, Oregon Health and Science University, Portland, Oregon, USA.
J Neurosurg. 2006 Nov;105(5 Suppl):365-9. doi: 10.3171/ped.2006.105.5.365.
The purpose of this study was to evaluate the risk of progression of traumatic intracranial lesions in children by comparing initial and subsequent computed tomography (CT) scans. Reserving repeated CT imaging for patients who harbor higher-risk lesions may reduce overall radiation exposure, the need for sedative agents, and cost.
The authors performed a retrospective cohort study in 268 patients younger than 18 years of age who underwent repeated CT scanning within 24 hours of their initial CT scanning procedure. The risk of progression between the initial and repeated CT scanning sessions and the need for delayed neurosurgical intervention were determined for each lesion type. In 54 patients (20.1%) the normal findings on the initial CT study did not change on subsequent imaging. In 61 (28.5%) of the 214 patients in whom abnormal findings were present on the initial scan, progression was demonstrated. Patients with epidural hematoma (EDH; odds ratio [OR] 12.29), subdural hematoma (SDH; OR 3.18), cerebral edema (OR 9.34), and intraparenchymal hemorrhage (IPH; OR 18.3) were found to be at a significantly increased risk for progression and to require delayed neurosurgical intervention (OR 11.91). No significantly increased risk was found for patients with subarachnoid hemorrhage (SAH), intraventricular hemorrhage (IVH), diffuse axonal injury (DAI), or skull fracture.
Repeated CT imaging in children with high-risk lesions such as EDH, SDH, cerebral edema, and IPH is recommended. However, in children with low-risk lesions, such as SAH, IVH, DAI, and isolated skull fractures but no sign of clinical deterioration, repeated imaging may be less likely to alter the clinical management scheme. The limited benefits of undertaking repeated imaging in these patients should be weighed against the risks of radiation exposure, sedation, intrahospital transportation, and patient monitoring.
本研究旨在通过比较初次和后续的计算机断层扫描（CT）来评估儿童创伤性颅内病变进展的风险。为患有高风险病变的患者保留重复CT成像可能会减少总体辐射暴露、镇静剂的使用需求和成本。
作者对268名18岁以下在初次CT扫描后24小时内接受重复CT扫描的患者进行了一项回顾性队列研究。确定每种病变类型在初次和重复CT扫描期间进展的风险以及延迟神经外科干预的必要性。在54名患者（20.1%）中，初次CT检查的正常结果在后续成像中未发生变化。在初次扫描有异常结果的214名患者中，有61名（28.5%）出现了病变进展。发现硬膜外血肿（EDH；优势比[OR]12.29）、硬膜下血肿（SDH；OR 3.18）、脑水肿（OR 9.34）和脑实质内出血（IPH；OR 18.3）的患者进展风险显著增加，且需要延迟神经外科干预（OR 11.91）。蛛网膜下腔出血（SAH）、脑室内出血（IVH）、弥漫性轴索损伤（DAI）或颅骨骨折患者未发现显著增加的风险。
建议对患有高风险病变如EDH、SDH、脑水肿和IPH的儿童进行重复CT成像。然而，对于患有低风险病变如SAH、IVH、DAI和单纯颅骨骨折但无临床恶化迹象的儿童，重复成像可能不太可能改变临床管理方案。应权衡对这些患者进行重复成像的有限益处与辐射暴露、镇静、院内转运和患者监测的风险。
