PEDIATRIC HEAD-INJURIES - CAN CLINICAL FACTORS RELIABLY PREDICT AN ABNORMALITY ON COMPUTED-TOMOGRAPHY

被引：126

作者：

DIETRICH, AM

BOWMAN, MJ

GINNPEASE, ME

KOSNIK, E

KING, DR

机构：

[1] Section of Emergency Medicine, Department of Pediatrics, Columbus, OH

[2] Divisions of Pediatric Surgery, Columbus, OH

[3] Neurosurgery, Columbus, OH

[4] Department of Surgery, The Ohio State University, College of Medicine, Columbus, OH

来源：

ANNALS OF EMERGENCY MEDICINE | 1993年 / 22卷 / 10期

关键词：

computed tomography; traumatic brain injury;

D O I：

10.1016/S0196-0644(05)81254-5

中图分类号：

R4 [临床医学];

学科分类号：

1002 ; 100602 ;

摘要：

Study objective: To assess clinical features that might reliably predict the need for computed tomography (CT) imaging in pediatric head trauma. Design/setting/type of participant: Prospective cohort of 324 head CT scans performed on 322 consecutive trauma patients at an urban children's hospital. Results: Sixty-two percent of patients were male. The mean age was 7.1 years (10 days to 20.6 years); half were less than 5 years of age. The two most frequent mechanisms of injury were falls (32%) and motor vehicle accidents (25%). Abnormalities were detected in 74 scans. Intracranial injuries were apparent in 39 patients (12%); 16 had a concomitant fracture. An isolated cranial abnormality was observed on 35 scans (11%). Loss of consciousness, amnesia for the event, a Glasgow Coma Scale (GCS) of less than 15, and the presence of a neurologic deficit were more common in children with intracranial injury (P<.05). Vomiting, seizures, and headache were not discriminating clinical features. No single characteristic consistently identified the children with an intracranial injury. Of the 195 children who were neurologically intact (GCS, 15) at the time of presentation, 11 (5%) had evidence of intracranial pathology on CT scan. Conclusion: This study demonstrates a poor correlation between the clinical symptoms of significant traumatic brain injury and findings on CT.

引用

页码：1535 / 1540

页数：6

共 16 条

[1] Hennes, Lee, Smith, Et al., Clinical predictors of severe head trauma in children, Am J Dis Child, 142, pp. 1045-1051, (1988)
[2] Bonadio, Smith, Hillman, Clinical indicators of intracranial lesion on computed tomographic scan in children with parietal skull fracture, Am J Dis Child, 143, pp. 194-196, (1989)
[3] Ros, Ros, Should patients with normal cranial CT scans following minor head injury be hospitalized for observation?, Pediatr Emerg Med, 5, pp. 216-218, (1989)
[4] Jennett, Teesdale, Aspects of coma after severe head injury, Lancet, 1, pp. 878-881, (1977)
[5] Raimonds, Hirschauer, Head injury in the infant and toddler: Coma scoring and outcome scale, Child's Brain, 11, pp. 12-35, (1984)
[6] Stein, O'Malley, Ross, Is routine computed tomography scanning too expensive for mild head injury?, Annals of Emergency Medicine, 20, pp. 1286-1289, (1992)
[7] Livingston, Loder, Koziol, Et al., The use of CT scanning to triage patients requiring admission following minimal head injury, J Trauma, 31, pp. 483-489, (1991)
[8] McMicken, Emergency CT scans in traumatic and atraumatic conditions, Ann Emerg Med, 15, pp. 274-279, (1986)
[9] Mohanty, Thompson, Rakowers, Are CT scans for head injured patients always necessary?, J Trauma, 31, pp. 801-805, (1991)
[10] Rivara, Tanaguchi, Parish, Et al., Poor prediction of positive computed tomographic scans by clinical criteria in symptomatic pediatric head trauma, Pediatrics, pp. 579-584, (1987)

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