J Korean Neurosurg Soc.  2015 Aug;58(2):125-130. 10.3340/jkns.2015.58.2.125.

Is Routine Repeated Head CT Necessary for All Pediatric Traumatic Brain Injury?

• Kim WH
• Lim DJ
• Kim SH
• Ha SK
• Choi JI
• Kim SD

• KMID: 2191320
• DOI: http://doi.org/10.3340/jkns.2015.58.2.125

Abstract

OBJECTIVE
Repeated computed tomography (CT) follow up for traumatic brain injury (TBI) patients is often performed. But there is debate the indication for repeated CT scans, especially in pediatric patients. Purpose of our study is to find risk factors of progression on repeated CT and delayed surgical intervention based on the repeated head CT.
METHODS
Between March, 2007 and December, 2013, 269 pediatric patients (age 0-18 years) had admitted to our hospital for head trauma. Patients were classified into 8 subgroups according to mechanisms of injury. Types, amount of hemorrhage and amount changes on repeated CT were analyzed as well as initial Glasgow Coma Scale (GCS) scores.
RESULTS
Within our cohort of 269 patients, 174 patients received repeat CT. There were progression in the amount of hemorrhage in 48 (27.6%) patients. Among various hemorrhage types, epidural hemorrhage (EDH) more than 10 cc measured in initial CT was found to be at risk of delayed surgical intervention significantly after routine repeated CT with or without neurological deterioration than other types of hemorrhage. Based on initial GCS, severe head trauma group (GCS 3-8) was at risk of delayed surgical intervention after routine repeated CT without change of clinical neurologic status.
CONCLUSION
We suggest that the patients with EDH more than 10 cc or GCS below 9 should receive repeated head CT even though absence of significant clinical deterioration.

Keyword

Computed tomography; Cranial epidural hemorrhage; Glasgow Coma Scale; Traumatic brain injury

MeSH Terms

Brain Injuries*
Cohort Studies
Craniocerebral Trauma
Follow-Up Studies
Glasgow Coma Scale
Head*
Hematoma, Epidural, Cranial
Hemorrhage
Humans
Risk Factors
Tomography, X-Ray Computed

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