Emergency Medicine Attending, Ankara Etlik City Hospital, Ankara-Türkiye.
Emergency Medicine Attending, Ankara Bilkent City Hospital, Ankara-Türkiye.
Ulus Travma Acil Cerrahi Derg. 2024 Aug;30(8):596-602. doi: 10.14744/tjtes.2024.28368.
Head trauma is a leading cause of death and disability. While standard treatment protocols exist for severe head trauma, no clear follow-up standards are available for mild head trauma with positive imaging findings in infants and newborns. Although routine follow-up brain computed tomography (CT) imaging is not recommended for children with moderate and mild head trauma, the necessity for follow-up imaging in infants and newborns remains uncertain.
Our study is a retrospective, observational, and descriptive study. Infants under 1 year old presenting to the emergency department with isolated head trauma were reviewed with the approval of the Ethics Committee of Ankara Etlik City Hospital. Inclusion criteria included presentation to the emergency department, undergoing more than one brain CT scan, and sustaining mild head trauma (Glasgow Coma Scale [GCS] >13). Patients with incomplete follow-up data or multiple traumas were excluded. Age, gender, mechanism of trauma, initial and follow-up brain CT findings, hospital admission, and surgical procedures were recorded and analyzed using the SPSS statistical package.
Out of 238 screened patients, 154 were included in the study. Of these, 66.9% were male and the average age was 5.99 months. The most common presenting symptom was swelling at the trauma site, observed in 79.2% of cases. The most common mechanism of injury was falling from a height of less than 90 cm, accounting for 85.1% of cases. Pathological progression on follow-up CT was observed in 5.2% of the patients, and only 1.9% required surgical treatment. A total of 34.4% of the patients required hospitalization. Patients with parenchymal brain pathology had a higher rate of pathological progression on follow-up CT and a longer hospital stay.
Follow-up CT scans in infants with mild head trauma do not alter patient outcomes except in cases with brain parenchymal pathology. Study data indicated that repeat imaging is not beneficial for isolated skull fractures. Imaging artifacts often necessitated repeated scans, contributing to increased radiation exposure. Unnecessary repeat imaging escalates radiation exposure and healthcare costs. Only a small percentage of patients exhibited progression of intracranial pathology, justifying follow-up imaging solely in the presence of brain parenchymal injury. Larger prospective studies are necessary to confirm these findings.
头部创伤是导致死亡和残疾的主要原因。虽然存在严重头部创伤的标准治疗方案，但对于婴儿和新生儿中影像学阳性的轻度头部创伤，尚无明确的随访标准。尽管对于中重度头部创伤患儿不建议常规进行随访脑计算机断层扫描（CT）成像，但婴儿和新生儿是否需要随访成像仍不确定。
本研究为回顾性、观察性和描述性研究。在安卡拉 Etlik 城市医院伦理委员会的批准下，对因孤立性头部创伤就诊于急诊科的 1 岁以下婴儿进行了研究。纳入标准包括就诊于急诊科、接受多次脑 CT 扫描和轻度头部创伤（格拉斯哥昏迷量表[GCS]＞13）。排除标准包括随访资料不完整或多处创伤的患者。使用 SPSS 统计软件包记录并分析年龄、性别、创伤机制、初始和随访脑 CT 结果、住院和手术情况。
在筛选出的 238 例患者中，154 例纳入研究。其中，66.9%为男性，平均年龄为 5.99 个月。最常见的首发症状是创伤部位肿胀，占 79.2%。最常见的损伤机制是从 90cm 以下的高度坠落，占 85.1%。5.2%的患者在随访 CT 上观察到病理性进展，仅 1.9%需要手术治疗。共有 34.4%的患者需要住院治疗。脑实质病变患者在随访 CT 上的病理性进展发生率更高，住院时间更长。
除脑实质病变外，轻度头部创伤婴儿的随访 CT 扫描不会改变患者的结局。研究数据表明，重复成像对单纯颅骨骨折无益。成像伪影通常需要重复扫描，导致辐射暴露增加。不必要的重复成像会增加辐射暴露和医疗保健成本。只有一小部分患者表现出颅内病理变化，仅在存在脑实质损伤时才需要进行随访成像。需要进行更大规模的前瞻性研究来证实这些发现。
