对于所有轻度创伤性脑损伤的儿童，常规重复进行脑计算机断层扫描可能导致不必要的辐射暴露。
Routine repeat brain computed tomography in all children with mild traumatic brain injury may result in unnecessary radiation exposure.
机构信息
From the Cardinal Glennon Children's Medical Center (J.H., D.R.L., A.G., D.W.V.), St. Louis, Missouri; and St. Louis CSTARS (C.M.F.), St. Louis University, St. Louis, Missouri.
出版信息
J Trauma Acute Care Surg. 2014 Feb;76(2):292-5; discussion 295-6. doi: 10.1097/TA.0000000000000119.
BACKGROUND
Computed tomography (CT) for pediatric traumatic brain injury (TBI) is common. Evidence suggests that 1 in 1,200 children undergoing CT will die of malignancy from radiation exposure. Presently, there is no protocol for surveying children with mild TBI; repeat CT (rCT) is often performed. We hypothesized that rCT could be avoided. Outcomes of similar patients who underwent rCT were compared with those of patients followed by clinical examination alone.
METHODS
An 8-year retrospective review was performed of patients admitted to a Level I pediatric trauma center with TBI, CT evidence of TBI, and Glasgow Coma Scale (GCS) score of 14 to 15. There were two groups, those who underwent rCT (rCT+) and those who did not (rCT-). Data included age, Injury Severity Score (ISS), mechanism of injury, type of TBI, and outcome. Patients with coagulopathies, ventriculoperitoneal shunts, developmental disabilities, nonaccidental trauma, concomitant injuries, or medical problems resulting in intubation or sedation not attributed to TBI were excluded.
RESULTS
Of 391 patients admitted with TBI, 120 were included in the study. A total of 106 patients were rCT+, and 14 were rCT-. rCT+ children were older (mean, 98.7 ± 7.3 vs. 35.3 ± 11.5 months; p = 0.0025) and more likely to have epidural hematoma (EDH) (100% rCT with EDH vs. 76% rCT all other TBI, p = 0.044). Mechanism of injury and mean ISS (15.2 ± 0.6 vs. 13.0 ± 1.1, p = 0.195) were not different between the groups. There were no worsening neurologic symptoms or need for surgery in rCT- children. rCT identified seven patients (6.6%) with CT progression of their injury. Five had an EDH, and two had a subarachnoid hemorrhage. Two children with EDH underwent operation.
CONCLUSION
Our study indicates that routine rCT without evidence of clinical deterioration is not indicated in children with admission GCS score of 14 to 15 and TBI on CT scan. Children with EDH seem to have a higher potential for progression, and rCT seems to be indicated in this subgroup.
LEVEL OF EVIDENCE
Therapeutic study, level IV.
背景
儿童创伤性脑损伤（TBI）的计算机断层扫描（CT）很常见。有证据表明，每 1200 名接受 CT 检查的儿童中就有 1 名会因辐射暴露而死于恶性肿瘤。目前，对于轻度 TBI 患儿没有调查方案；经常进行重复 CT（rCT）检查。我们假设可以避免 rCT。比较了接受 rCT 的类似患者的结果与仅接受临床检查的患者的结果。
方法
对 8 年来在 I 级儿科创伤中心因 TBI 、 TBI 的 CT 证据和格拉斯哥昏迷量表（GCS）评分 14-15 分而入院的患者进行了回顾性研究。有两组，一组是接受 rCT（rCT+）的患者，另一组是未接受 rCT（rCT-）的患者。数据包括年龄、损伤严重程度评分（ISS）、损伤机制、TBI 类型和结果。排除了凝血功能障碍、脑室-腹腔分流、发育障碍、非意外伤害、合并损伤或因 TBI 导致插管或镇静的医疗问题的患者。
结果
在因 TBI 入院的 391 名患者中，有 120 名患者纳入研究。共有 106 例患者行 rCT+，14 例患者行 rCT-。rCT+患儿年龄较大（平均 98.7±7.3 岁 vs. 35.3±11.5 岁；p=0.0025），硬膜外血肿（EDH）发生率更高（100%rCT+伴 EDH 与 76%rCT+伴其他 TBI ；p=0.044）。两组患儿的损伤机制和平均 ISS（15.2±0.6 vs. 13.0±1.1，p=0.195）无差异。rCT-患儿无神经症状恶化或手术需要。rCT 在 7 名（6.6%）患儿的损伤进展中发现 CT 表现。其中 5 例有 EDH，2 例有蛛网膜下腔出血。2 例 EDH 患儿行手术治疗。
结论
我们的研究表明，对于入院时 GCS 评分为 14-15 分且 CT 扫描有 TBI 的儿童，无临床恶化证据时，不建议常规进行 rCT。硬膜外血肿患儿的进展可能性较高，该亚组似乎需要进行 rCT。
证据水平
治疗研究，IV 级。
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