Department of Neurosurgery, University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey; Department of Neurosurgery, Hacettepe University Faculty of Medicine, Ankara, Turkey.
Division of Pediatric Emergency Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey.
World Neurosurg. 2022 Sep;165:e102-e109. doi: 10.1016/j.wneu.2022.05.103. Epub 2022 May 30.
The necessity of computed tomography (CT) has been questioned in pediatric mild traumatic brain injury (mTBI) because of concerns related to radiation exposure. Distinguishing patients with lower and higher risk of clinically important TBI (ciTBI) is paramount to the optimal management of these patients.
This study aimed to analyze the imaging predictors of ciTBI and develop an algorithm to identify patients at low and high risk for ciTBI to inform clinical decision making using a large single-center cohort of pediatric patients with mTBI.
We retrospectively identified pediatric patients with mTBI with repeat CT within 48 hours of injury using an institutional database.
Among 3867 pediatric patients, 219 patients with mTBI with repeat CT were included. Thirty-eight had ciTBI (17%), 16 (7%) required intensive care unit admission, and 6 (3%) underwent surgery. Median time interval between initial and repeat CT was 7 hours (range, 4-10). Clinical worsening and radiologic progression were evident in 36 (16%) and 24 (11%) patients, respectively. Multivariate analysis showed that 5 pathologic findings (depressed skull fracture, pneumocephalus, epidural hematoma, subdural hematoma, and contusion) on initial CT and radiologic progression on repeat CT were independent predictors of ciTBI. A new scoring system based on these 5 factors on initial CT (IniCT [Initial CT scoring system] score) had excellent discrimination for ciTBI, need for intensive care unit admission, and neurosurgery (area under the curve >0.8).
The IniCT scoring system can successfully differentiate low-risk and high-risk patients based on initial CT scan. Zero score can eliminate the need for a routine repeat CT, whereas scores ≥2 should prompt serial neurologic examinations and/or repeat CT depending on the clinical situation.
由于担心辐射暴露，在儿科轻度创伤性脑损伤（mTBI）中已经对计算机断层扫描（CT）的必要性提出了质疑。区分低危和高危患者对于这些患者的最佳管理至关重要。
本研究旨在分析 ciTBI 的影像学预测因素，并开发一种算法，使用大型单中心儿科 mTBI 患者队列来识别 ciTBI 低危和高危患者，以指导临床决策。
我们使用机构数据库回顾性地确定了伤后 48 小时内进行重复 CT 的儿科 mTBI 患者。
在 3867 名儿科患者中，有 219 名 mTBI 患者进行了重复 CT。38 例患者发生 ciTBI（17%），16 例（7%）需要入住重症监护病房，6 例（3%）需要手术。初次 CT 和重复 CT 之间的中位时间间隔为 7 小时（范围，4-10 小时）。36 例（16%）患者出现临床恶化，24 例（11%）患者出现影像学进展。多变量分析显示，初次 CT 上的 5 种病理发现（凹陷性颅骨骨折、气颅、硬膜外血肿、硬膜下血肿和脑挫裂伤）和重复 CT 上的影像学进展是 ciTBI 的独立预测因素。一种新的评分系统，基于初次 CT 上的这 5 个因素（IniCT [初始 CT 评分系统]评分），对 ciTBI、需要入住重症监护病房和神经外科手术的预测效果良好（曲线下面积＞0.8）。
IniCT 评分系统可以根据初次 CT 扫描成功区分低危和高危患者。得分为 0 可消除常规重复 CT 的需求，而得分≥2 则应根据临床情况提示进行连续神经检查和/或重复 CT。
