Utility of serial computed tomography imaging in pediatric patients with head trauma

Susan R. Durham, Kenneth C. Liu, Nathan R. Selden

Research output: Contribution to journalArticle

36 Citations (Scopus)

Abstract

Object. The purpose of this study was to evaluate the risk of progression of traumatic intracranial lesions in children by comparing initial and subsequent computed tomography (CT) scans. Reserving repeated CT imaging for patients who harbor higher-risk lesions may reduce overall radiation exposure, the need for sedative agents, and cost. Methods. The authors performed a retrospective cohort study in 268 patients younger than 18 years of age who underwent repeated CT scanning within 24 hours of their initial CT scanning procedure. The risk of progression between the initial and repeated CT scanning sessions and the need for delayed neurosurgical intervention were determined for each lesion type. In 54 patients (20.1%) the normal findings on the initial CT study did not change on subsequent imaging. In 61 (28.5%) of the 214 patients in whom abnormal findings were present on the initial scan, progression was demonstrated. Patients with epidural hematoma (EDH; odds ratio [OR] 12.29), subdural hematoma (SDH; OR 3.18), cerebral edema (OR 9.34), and intraparenchymal hemorrhage (IPH; OR 18.3) were found to be at a significantly increased risk for progression and to require delayed neurosurgical intervention (OR 11.91). No significantly increased risk was found for patients with subarachnoid hemorrhage (SAH), intraventricular hemorrhage (IVH), diffuse axonal injury (DAI), or skull fracture. Conclusions. Repeated CT imaging in children with high-risk lesions such as EDH, SDH, cerebral edema, and IPH is recommended. However, in children with low-risk lesions, such as SAH, IVH, DAI, and isolated skull fractures but no sign of clinical deterioration, repeated imaging may be less likely to alter the clinical management scheme. The limited benefits of undertaking repeated imaging in these patients should be weighed against the risks of radiation exposure, sedation, intrahospital transportation, and patient monitoring.

Original languageEnglish (US)
Pages (from-to)365-369
Number of pages5
JournalJournal of neurosurgery
Volume105 PEDIATRICS
Issue numberSUPPL. 5
StatePublished - Nov 1 2006

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Craniocerebral Trauma
Tomography
Pediatrics
Odds Ratio
Diffuse Axonal Injury
Skull Fractures
Brain Edema
Subarachnoid Hemorrhage
Hemorrhage
Transportation of Patients
Subdural Hematoma
Physiologic Monitoring
Hypnotics and Sedatives
Hematoma
Cohort Studies
Retrospective Studies
Costs and Cost Analysis

All Science Journal Classification (ASJC) codes

  • Surgery
  • Clinical Neurology

Cite this

Durham, S. R., Liu, K. C., & Selden, N. R. (2006). Utility of serial computed tomography imaging in pediatric patients with head trauma. Journal of neurosurgery, 105 PEDIATRICS(SUPPL. 5), 365-369.
Durham, Susan R. ; Liu, Kenneth C. ; Selden, Nathan R. / Utility of serial computed tomography imaging in pediatric patients with head trauma. In: Journal of neurosurgery. 2006 ; Vol. 105 PEDIATRICS, No. SUPPL. 5. pp. 365-369.
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abstract = "Object. The purpose of this study was to evaluate the risk of progression of traumatic intracranial lesions in children by comparing initial and subsequent computed tomography (CT) scans. Reserving repeated CT imaging for patients who harbor higher-risk lesions may reduce overall radiation exposure, the need for sedative agents, and cost. Methods. The authors performed a retrospective cohort study in 268 patients younger than 18 years of age who underwent repeated CT scanning within 24 hours of their initial CT scanning procedure. The risk of progression between the initial and repeated CT scanning sessions and the need for delayed neurosurgical intervention were determined for each lesion type. In 54 patients (20.1{\%}) the normal findings on the initial CT study did not change on subsequent imaging. In 61 (28.5{\%}) of the 214 patients in whom abnormal findings were present on the initial scan, progression was demonstrated. Patients with epidural hematoma (EDH; odds ratio [OR] 12.29), subdural hematoma (SDH; OR 3.18), cerebral edema (OR 9.34), and intraparenchymal hemorrhage (IPH; OR 18.3) were found to be at a significantly increased risk for progression and to require delayed neurosurgical intervention (OR 11.91). No significantly increased risk was found for patients with subarachnoid hemorrhage (SAH), intraventricular hemorrhage (IVH), diffuse axonal injury (DAI), or skull fracture. Conclusions. Repeated CT imaging in children with high-risk lesions such as EDH, SDH, cerebral edema, and IPH is recommended. However, in children with low-risk lesions, such as SAH, IVH, DAI, and isolated skull fractures but no sign of clinical deterioration, repeated imaging may be less likely to alter the clinical management scheme. The limited benefits of undertaking repeated imaging in these patients should be weighed against the risks of radiation exposure, sedation, intrahospital transportation, and patient monitoring.",
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Durham, SR, Liu, KC & Selden, NR 2006, 'Utility of serial computed tomography imaging in pediatric patients with head trauma', Journal of neurosurgery, vol. 105 PEDIATRICS, no. SUPPL. 5, pp. 365-369.

Utility of serial computed tomography imaging in pediatric patients with head trauma. / Durham, Susan R.; Liu, Kenneth C.; Selden, Nathan R.

In: Journal of neurosurgery, Vol. 105 PEDIATRICS, No. SUPPL. 5, 01.11.2006, p. 365-369.

Research output: Contribution to journalArticle

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N2 - Object. The purpose of this study was to evaluate the risk of progression of traumatic intracranial lesions in children by comparing initial and subsequent computed tomography (CT) scans. Reserving repeated CT imaging for patients who harbor higher-risk lesions may reduce overall radiation exposure, the need for sedative agents, and cost. Methods. The authors performed a retrospective cohort study in 268 patients younger than 18 years of age who underwent repeated CT scanning within 24 hours of their initial CT scanning procedure. The risk of progression between the initial and repeated CT scanning sessions and the need for delayed neurosurgical intervention were determined for each lesion type. In 54 patients (20.1%) the normal findings on the initial CT study did not change on subsequent imaging. In 61 (28.5%) of the 214 patients in whom abnormal findings were present on the initial scan, progression was demonstrated. Patients with epidural hematoma (EDH; odds ratio [OR] 12.29), subdural hematoma (SDH; OR 3.18), cerebral edema (OR 9.34), and intraparenchymal hemorrhage (IPH; OR 18.3) were found to be at a significantly increased risk for progression and to require delayed neurosurgical intervention (OR 11.91). No significantly increased risk was found for patients with subarachnoid hemorrhage (SAH), intraventricular hemorrhage (IVH), diffuse axonal injury (DAI), or skull fracture. Conclusions. Repeated CT imaging in children with high-risk lesions such as EDH, SDH, cerebral edema, and IPH is recommended. However, in children with low-risk lesions, such as SAH, IVH, DAI, and isolated skull fractures but no sign of clinical deterioration, repeated imaging may be less likely to alter the clinical management scheme. The limited benefits of undertaking repeated imaging in these patients should be weighed against the risks of radiation exposure, sedation, intrahospital transportation, and patient monitoring.

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Durham SR, Liu KC, Selden NR. Utility of serial computed tomography imaging in pediatric patients with head trauma. Journal of neurosurgery. 2006 Nov 1;105 PEDIATRICS(SUPPL. 5):365-369.