Department of Neurosurgery, University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey.
Department of Neurosurgery, University of Health Sciences, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey.
Pediatr Emerg Care. 2023 Nov 1;39(11):836-840. doi: 10.1097/PEC.0000000000003060. Epub 2023 Oct 8.
Mild traumatic brain injury (mTBI) comprises most (70%-90%) of all pediatric head trauma cases seeking emergency care. Although most mTBI cases have normal initial head computed tomography scan, a considerable portion of the cases have intracranial imaging abnormalities on computed tomography scan. Whereas other intracranial pathological findings have been extensively studied, little is known about the clinical significance of pneumocephalus in pediatric mTBI.
We retrospectively identified pediatric mTBI patients with pneumocephalus using the institutional database of a large regional trauma referral center. Outcome measures were defined as clinically important TBI (ciTBI), hospitalization, intensive care unit (ICU) admission, and neurosurgical intervention. Comparisons were made between pneumocephalus and control (isolated linear fracture) groups as well as between isolated (only linear fracture and pneumocephalus) and nonisolated pneumocephalus (pneumocephalus and TBI) groups.
Among 3524 pediatric mTBI cases, 43 cases had pneumocephalus (1.2%). Twenty-one cases (48.8%) had isolated pneumocephalus. The pneumocephalus group had higher rates of ciTBI, hospital admission, ICU admission, and neurosurgery when compared with the isolated linear fracture (control) group. The isolated pneumocephalus group had fewer ciTBI (21.1% vs 70%, P = 0.002), fewer hospitalization (23.8% vs 81.8%, P < 0.001), but similar ICU admission rates (4.8% vs 22.7%, P = 0.089) and length of hospital stay (4.0 ± 2.7 vs 3.6 ± 2.4 days, P = 0.798) in comparison to the nonisolated pneumocephalus group. None of the patients in the isolated group had neurosurgery whereas 2 patients in the nonisolated pneumocephalus group underwent surgery. Multivariable analysis revealed pneumocephalus as an independent predictor of ciTBI and hospital admission, but not ICU admission or neurosurgical intervention.
Pneumocephalus is associated with increased rates of hospitalization and ciTBI, but not ICU admission, unfavorable outcome, or neurosurgical intervention in pediatric mTBI. Although usually spontaneously resolving pathology, it may occasionally be linked with complications such as cerebrospinal fluid leakage, meningitis, and tension pneumocephalus. Therefore, careful evaluation, close observation, and early detection of complications may prevent adverse outcomes.
轻度创伤性脑损伤（mTBI）占寻求急诊治疗的所有儿科头部创伤病例的 70%-90%。尽管大多数 mTBI 病例的初始头部计算机断层扫描正常，但相当一部分病例的计算机断层扫描显示颅内成像异常。虽然其他颅内病理发现已经得到了广泛研究，但关于儿童 mTBI 中气胸的临床意义知之甚少。
我们使用大型区域创伤转诊中心的机构数据库，回顾性地确定了有气胸的儿科 mTBI 患者。结局指标定义为临床重要性 TBI（ciTBI）、住院、重症监护病房（ICU）入院和神经外科干预。对气胸组和对照组（单纯线性骨折）以及单纯组（仅线性骨折和气胸）和非单纯组（气胸和 TBI）进行比较。
在 3524 例儿科 mTBI 病例中，有 43 例有气胸（1.2%）。21 例（48.8%）为单纯性气胸。与单纯线性骨折（对照组）相比，气胸组 ciTBI、住院、ICU 入院和神经外科手术的发生率更高。单纯性气胸组 ciTBI 发生率较低（21.1%比 70%，P=0.002）、住院率较低（23.8%比 81.8%，P<0.001），但 ICU 入院率相似（4.8%比 22.7%，P=0.089），住院时间（4.0±2.7 比 3.6±2.4 天，P=0.798）与非单纯性气胸组无差异。单纯性气胸组无一例患者接受神经外科手术，而非单纯性气胸组有 2 例患者接受手术。多变量分析显示，气胸是儿童 mTBI 中 ciTBI 和住院的独立预测因素，但不是 ICU 入院或神经外科干预的预测因素。
在儿科 mTBI 中，气胸与较高的住院率和 ciTBI 相关，但与 ICU 入院、不良结局或神经外科干预无关。尽管气胸通常是一种自发消退的病理，但它偶尔可能与脑脊液漏、脑膜炎和张力性气胸等并发症有关。因此，仔细评估、密切观察和早期发现并发症可能预防不良结局。
