Co-relation of CT scan findings with Glasgow coma scale scores in pediatric head injury

Authors

  • Ajay Kumar Jain Department of Surgery, PCMS & RC, Bhopal, M.P
  • Kailash Charokar Department of Surgery, PCMS & RC, Bhopal, M.P
  • Prateesh Agrawal Department of Surgery, PCMS & RC, Bhopal, M.P

DOI:

https://doi.org/10.18203/2349-2902.isj20151100

Keywords:

CT scan, head injury, pediatric, Glasgow Coma Scale Score

Abstract

Background:Head injury in pediatric age is a major cause of mortality and disability. Clinical selection of cases prior to ordering CT scan would be desirable to avoid unnecessary radiation exposure and risk of malignancy.

Methods: An observational study of 50 pediatric cases of head injury that underwent CT scan as part of routine diagnostic work up. Correlation of CT scan findings with GCS scores and clinical profile done.

Results:Contusion was the most frequent finding in cases with positive CT scan findings and majority (94%) of patients could be managed conservatively. Among the mild head injury cases only 1 (3.8%) had positive CT scan findings whereas 16 (80%) with moderate head injury and almost all (100%) subjects with severe head injury had positive CT scan findings.

Conclusions:Careful clinical selection based on GCS score before ordering CT scan can help reduce radiation exposure among pediatric patients and pressure on limited resources. Studies with larger sample size would be warranted.

References

Leite CC, Amaro Jr E, Lucato LT. Neurorradiologia-diagnostico por imagem das alteracoes encefalicas. Rio de Janeiro: Guanabara Koogan; 2008:182-214.

Kumar R, Mahapatra AK. The changing “epidemiology” of pediatric head injury and its impact on the daily clinical practice. Childs Nerv Syst. 2009;25:813-23.

Halley MK, Silva PD, Foley J, Rodarte A. Loss of consciousness: When to perform computed tomography? Pediatr Crit Care Med. 2004;5:230-3.

Rice HE, Frush DP, Farmer D, Waldhausen JH. APSA Education Committee. Review of radiation risks from computed tomography: Essentials for the pediatric surgeon. J Pediatr Surg. 2007;42:603-7.

Atabaki SM, Stiell IG, Bazarian JJ, Sadow KE, Vu TT, Camarca MA, et al. A clinical decision rule for cranial computed tomography in minor pediatric head trauma. Arch Pediatr Adolesc Med. 2008;162:439-45.

Osmond MH, Klassen TP, Wells GA, Correll R, Jarvis A, Joubert G, et al. CATCH: A clinical decision rule for the use of computed tomography in children with minor head injury. CMAJ. 2010;182(4):341-8.

Kraus JF, Black MA, Hessol N, et al. The incidence of acute brain injury and serious impairment in a defined population. Am J Epidemiol. 1984;119:186–201.

Ng SM, Toh EM, Sherrington CA. Clinical predictors of abnormal computed tomography scans in paediatric head injury. J Paediat Child Health. 2002;38(4):388-92.

Fundaro C, Caldarelli M, Monaco S, Cota F, Giorgio V, Onesimo R, et al. Brain CT scan for pediatric minor accidental head injury. An Italian experience and review of literature. Child's Nervous System: Chns: Official Journal Of The International Society For Pediatric Neurosurgery. 2012;28(7):1063-8.

Palchak MJ, Holmes JF, Vance CW, et al. A decision rule for identifying children at low risk for brain injuries after blunt head trauma. Ann Emerg Med. 2003;42:492-506.

Guzel A, Hicdonmez T, Temizoz O, Aksu B, Aylanc H, Karasalihoglu S. Indications for brain computed tomography and hospital admission pediatric patients with minor head injury: how much can we rely upon clinical findings? Pediatr Neurosurg. 2009;45:262-70.

Arienta C, Caroli M, Balbi S. Management of head-injured patients in the emergency department: a practical protocol. Surg Neurol. 1997;48:213-9.

Gomez P, Lobato R, Ortega J, De La Cruz J. Mild head injury: differences in prognosis among patients with a Glasgow Coma Scale score of 13 to 15 and analysis of factors associated with abnormal CT findings. British Journal of Neurosurgery. 1996;10(5):453-60.

Mohanty SK, Thompson W, Rakower S. Are CT scans for head injury patients always necessary? J Trauma. 1991;31:801-5.

Downloads

Published

2016-12-14

Issue

Section

Original Research Articles