Journal of Trauma and Injury

  • 제28권3호
  • /
  • Pages.149-157
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  • 2015
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  • 2799-4317(pISSN)
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  • 2287-1683(eISSN)
대한외상학회 (The Korean Society of Traumatology)
권호 표지

소아 두부외상 환자에서의 반복적인 두부 CT 검사의 유용성

Value of Repeat Brain Computed Tomography in Children with Traumatic Brain Injury

  • 조호준 (가천대학교 길병원 응급의학과) ;
  • 임용수 (가천대학교 길병원 응급의학과) ;
  • 김진주 (가천대학교 길병원 응급의학과) ;
  • 조진성 (가천대학교 길병원 응급의학과) ;
  • 현성열 (가천대학교 길병원 응급의학과) ;
  • 양혁준 (가천대학교 길병원 응급의학과) ;
  • 이근 (가천대학교 길병원 응급의학과)
  • Jo, Ho jun (Department of Emergency Medicine, Gachon University Gil Medical Center) ;
  • Lim, Yong Su (Department of Emergency Medicine, Gachon University Gil Medical Center) ;
  • Kim, Jin Joo (Department of Emergency Medicine, Gachon University Gil Medical Center) ;
  • Cho, Jin Seong (Department of Emergency Medicine, Gachon University Gil Medical Center) ;
  • Hyun, Sung Youl (Department of Emergency Medicine, Gachon University Gil Medical Center) ;
  • Yang, Hyuk Jun (Department of Emergency Medicine, Gachon University Gil Medical Center) ;
  • Lee, Gun (Department of Emergency Medicine, Gachon University Gil Medical Center)
  • 투고 : 2015.08.13
  • 심사 : 2015.10.04
  • 발행 : 2015.09.30
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초록

Purpose: Traumatic brain injury (TBI) is the most common cause of pediatric trauma patients came to the emergency department. Without guidelines, many of these children underwent repeat brain computed tomography (CT). The purpose of this study was to evaluate the value of repeat brain CT in children with TBI. Methods: We conducted a retrospective study of TBI in children younger than 19 years of age who visited the emergency department (ED) from January 2011 to December 2012. According to the Glasgow Coma Scale (GCS) and Pediatric Glasgow Coma Scale score of the patients, study population divided in three groups. Clinical data collected included age, mechanism of injury, type of TBI, and outcome. Results: A Total 83 children with TBI received repeat brain CT. There were no need for neurosurgical intervention in mild TBI (GCS score 13-15) group who underwent routine repeat CT. 4 patients of mild TBI group, received repeat brain CT due to neurological deterioration, and one patient underwent neurosurgical intervention. Routine repeat CT identified 12 patients with radiographic progression. One patient underwent neurosurgical intervention based on the second brain CT finding, who belonged to the moderate TBI (GCS score 9-12) group. Conclusion: Our study showed that children with mild TBI can be observed without repeat brain CT when there is no evidence of neurologic deterioration. Further study is needed for establish indication for repetition of CT scan in order to avoid unnecessary radiation exposure of children.

키워드

참고문헌

  1. Kraus JF, Rock A, Hemyari P. Brain injuries among infants, children, adolescents, and young adults. Am J Dis Child 1990; 144: 684-91.
  2. Coronado VG, Xu L, Basavaraju SV, McGuire LC, Wald MM, Faul MD, et al. Surveillance for traumatic brain injuryrelated deaths--United States, 1997-2007. MMWR Surveill Summ 2011; 60: 1-32.
  3. Maguire JL, Boutis K, Uleryk EM, Laupacis A, Parkin PC. Should a head-injured child receive a head CT scan? A systematic review of clinical prediction rules. Pediatrics 2009; 124: e145-54. https://doi.org/10.1542/peds.2009-0075
  4. Traumatic brain injury in the United States: Emergency department visits, hospitalizations and deaths 2002-2006. [Internet]. 2010 Mar [Accessed 2013 Jan 7]. Available from: http://www.cdc.gov/traumaticbraininjury
  5. Durham SR, Liu KC, Selden NR. Utility of serial computed tomography imaging in pediatric patients with head trauma. J Neurosurg 2006; 105: 365-9.
  6. Brain injury statistics. [Internet]. 2010 [Accessed 2013 Jan 4]. Available from: http://www.BrainandSpinalCord.org.
  7. Schnadower D, Vazquez H, Lee J, Dayan P, Roskind CG. Controversies in the evaluation and management of minor blunt head trauma in children. Curr Opin Pediatr 2007; 19: 258-64. https://doi.org/10.1097/MOP.0b013e3281084e85
  8. Pearce MS, Salotti JA, Little MP, McHugh K, Lee C, Kim KP, et al. Radiation exposure from CT scans in childhood and subsequent risk of leukaemia and brain tumours: a retrospective cohort study. Lancet 2012; 380: 499-505. https://doi.org/10.1016/S0140-6736(12)60815-0
  9. Kuppermann N, Holmes JF, Dayan PS, Hoyle JD Jr, Atabaki SM, Holubkov R, et al. Identification of children at very low risk of clinically-important brain injuries after head trauma: a prospective cohort study. Lancet 2009; 374: 1160-70. https://doi.org/10.1016/S0140-6736(09)61558-0
  10. Dacey RG Jr, Alves WM, Rimel RW, Winn HR, Jane JA. Neurosurgical complications after apparently minor head injury. Assessment of risk in a series of 610 patients. J Neurosurg 1986; 65: 203-10. https://doi.org/10.3171/jns.1986.65.2.0203
  11. Rivara F, Tanaguchi D, Parish RA, Stimac GK, Mueller B. Poor prediction of positive computed tomographic scans by clinical criteria in symptomatic pediatric head trauma. Pediatrics 1987; 80: 579-84.
  12. Patel NY, Hoyt DB, Nakaji P, Marshall L, Holbrook T, Coimbra R et al. Traumatic brain injury: patterns of failure of nonoperative management. J Trauma 2000; 48: 367-74. https://doi.org/10.1097/00005373-200003000-00001
  13. Figg RE, Burry TS, Vander Kolk WE. Clinical efficacy of serial computed tomographic scanning in severe closed head injury patients. J Trauma 2003; 55: 1061-4. https://doi.org/10.1097/01.TA.0000096712.90133.5C
  14. Rimel RW, Giordani B, Barth JT, Jane JA. Moderate head injury: completing the clinical spectrum of brain trauma. Neurosurgery 1982; 11: 344-51. https://doi.org/10.1227/00006123-198209000-00002
  15. Tepas JJ 3rd, DiScala C, Ramenofsky ML, Barlow B. Mortality and head injury: the pediatric perspective. J Pediatr Surg 1990; 25: 92-5. https://doi.org/10.1016/S0022-3468(05)80170-8
  16. Kraus JF, Fife D, Cox P, Ramstein K, Conroy C. Incidence, severity, and external causes of pediatric brain injury. Am J Dis Child. 1986;140:687-93.
  17. Vane DW, Shackford SR. Epidemiology of rural traumatic death in children: a population-based study. J Trauma 1995; 38: 867-70. https://doi.org/10.1097/00005373-199506000-00006
  18. Giza CC, Mink RB, Madikians A. Pediatric traumatic brain injury: not just little adults. Curr Opin Crit Care 2007; 13: 143-52. https://doi.org/10.1097/MCC.0b013e32808255dc
  19. Maguire JL, Boutis K, Uleryk EM, Laupacis A, Parkin PC. Should a head-injured child receive a head CT scan? A systematic review of clinical prediction rules. Pediatrics 2009; 124: e145-54. https://doi.org/10.1542/peds.2009-0075
  20. Hollingworth W, Vavilala MS, Jarvik JG, Chaudhry S, Johnston BD, Layman S, et al. The use of repeated head computed tomography in pediatric blunt head trauma: factors predicting new and worsening brain injury. Pediatr Crit Care Med 2007; 8: 348-56.
  21. Aziz H, Rhee P, Pandit V, Ibrahim-Zada I, Kulvatunyou N, Wynne J, et al. Mild and moderate pediatric traumatic brain injury: replace routine repeat head computed tomography with neurologic examination. J Trauma Acute Care Surg 2013; 75: 550-4. https://doi.org/10.1097/TA.0b013e3182a53a77
  22. Howe J, Fitzpatrick CM, Lakam DR, Gleisner A, Vane DW. Routine repeat brain computed tomography in all children with mild traumatic brain injury may result in unnecessary radiation exposure. J Trauma Acute Care Surg 2014; 76: 292-5. https://doi.org/10.1097/TA.0000000000000119
  23. da Silva PS, Reis ME, Aguiar VE. Value of repeat cranial computed tomography in pediatric patients sustaining moderate to severe traumatic brain injury. J Trauma 2008; 65: 1293-7. https://doi.org/10.1097/TA.0b013e318156866c
  24. Tabori U, Kornecki A, Sofer S, Constantini S, Paret G, Beck R, et al. Repeat computed tomographic scan within 24-48 hours of admission in children with moderate and severe head trauma. Crit Care Med 2000; 28: 840-4. https://doi.org/10.1097/00003246-200003000-00038