Division of Pediatric Emergency, Department of Pediatrics, Gazi University Faculty of Medicine, Ankara, Turkey.
Department of Pediatrics, Gazi University Faculty of Medicine, Ankara, Turkey.
Eur J Trauma Emerg Surg. 2023 Aug;49(4):1673-1681. doi: 10.1007/s00068-022-02085-9. Epub 2022 Sep 3.
Our study sought to externally validate the Infant Scalp Score (ISS) within an international pediatric emergency department (PED) setting. The ISS for pediatric Closed Head Injury (CHI), includes age, hematoma localization, and size, and has the potential to predict the presence of Traumatic Brain Injury (TBI) on computed tomography. We aimed to describe a potentially low risk cohort of children younger than 24 months with CHI and scalp hematomas, where clinicians may limit diagnostic radiation exposure to this vulnerable patient population.
This single-center retrospective study was conducted in Gazi University. Faculty of Medicine, Pediatric Emergency Department, a tertiary trauma care hospital. We reviewed patients (< 24 months) with CHI and scalp hematoma who visited the PED of our institution between January 1, 2019, and June 30, 2021 for rates of TBI and clinically important TBI (ciTBI).
380 cases met inclusion criteria for this study. The median age was 11 months and 58.7% were male children. 121 (31.8%) patients underwent CT, and 57% (n:69) of these studies were normal. TBI on CT was found in 26 (21.5%) patients with ciTBI was detected in 5 (1.3%) patients. All children with TBI were noted to have ISS scores of ≥ 5. Hematoma location OR 18.9 (95% CI, 3.4-105.1) and hematoma size OR 3.0 (95% CI, 1.2-7.3) were positively associated with presence of TBI.
Children with ISS scores of ≥ 5 were noted to have increased rates of both TBI and ciTBI. CHI related scalp hematomas located in the temporal/parietal region or with a size greater than 3 cm were associated with increased rates of TBI. Within the context of this study, ISS scores of 4 or less represented a lower risk for TBI and ciTBI. Future research on this potentially low risk pediatric CHI cohort is needed.
本研究旨在国际儿科急诊环境中对婴儿头皮评分（ISS）进行外部验证。小儿闭合性颅脑损伤（CHI）的 ISS 包括年龄、血肿定位和大小，具有预测 CT 上存在创伤性脑损伤（TBI）的潜力。我们旨在描述一个潜在低风险的小儿 CHI 伴头皮血肿患儿队列，临床医生可能会限制该脆弱患者群体的诊断辐射暴露。
这是一项单中心回顾性研究，在加齐大学医学院儿科急诊部进行，该医院是一家三级创伤护理医院。我们回顾了 2019 年 1 月 1 日至 2021 年 6 月 30 日期间因 CHI 和头皮血肿就诊于我们机构儿科急诊的年龄<24 个月的患儿，以评估 TBI 和临床重要 TBI（ciTBI）的发生率。
本研究共纳入 380 例病例。中位年龄为 11 个月，58.7%为男性儿童。121 例（31.8%）患儿行 CT 检查，其中 57%（n：69）的 CT 检查结果正常。26 例（21.5%）患儿 CT 发现 TBI，5 例（1.3%）患儿发现 ciTBI。所有 TBI 患儿的 ISS 评分均≥5。血肿位置 OR 18.9（95%CI，3.4-105.1）和血肿大小 OR 3.0（95%CI，1.2-7.3）与 TBI 的存在呈正相关。
ISS 评分≥5 的患儿 TBI 和 ciTBI 发生率均较高。位于颞顶区或大小大于 3cm 的 CHI 相关头皮血肿与 TBI 发生率增加相关。在本研究中，ISS 评分 4 或更低代表 TBI 和 ciTBI 的风险较低。需要对这个潜在低风险的小儿 CHI 队列进行进一步研究。
