Öz
Objective: Head trauma is one of the most common causes for applying to the emergency department in
children. Minor head trauma constitutes a large part of these applications. In this study; demographic characteristics,
clinical and computed tomography (CT) findings of children with blunt head trauma admitted to the
emergency department were evaluated. The role of computed tomography (CT) in follow-up and evaluation
of these group of patients was also examined with this study.
Material and Method: Two hundred patients admitted to the emergency department with head trauma between
January 2007 and January 2009 were included in this retrospective study. Two patients were excluded
from the study because of insufficient information about these patients. The clinical and demographic findings
of the patients including age, gender, trauma type, physical examination findings, and associated systemic
diseases were evaluated in this study.
Results: According to the Glasgow Coma Scale (GCS) of patients; 99.5% (197) of patients had mild (GCS:
13-15) and 0.5% (1) of patients had a severe head injury (GCS: 5). One patient had von-Willebrand factor
deficiency. Although most of the patients had a domestic accident, one patient with severe head trauma had
fallen from altitudes. Among 197 patients with minor head trauma underwent CT, 6 had linear fractures
andone of them had 2 mm epidural hematoma. Furthermore, there is fracture, multiple contusions, and two
epidural hematoma with diameters of 5-mm and 3-mm in a patient with severe head trauma. All patients undertaken
CT had scalp and/or facial laceration and/or hematoma.
Conclusion: The high ratio of CT used in patients with minor head trauma was remarkably high. It was
thought that the anxiety of families caused by lacerations and/or hematomas of all the patients undertaken CT
mislead the physician for deciding to use CT. When the frequency of minor trauma in childhood and radiation
exposure due to CT in each trauma is considered; the clinical follow up and neurological examination remain
in the first place despite advanced imaging methods.
Key Words: Minor, head injury, computed tomography,
Anahtar Kelimeler
Kaynakça
- 1. Atabaki SM. Pediatric head injury. Pediatr Rev 2007;28(6):215-24.
- 2. Derek AB. Pediatric head injury. In: Wilkins RH, Rengachary SS, eds. Neurosurgery. 2nd ed. New York: McGraw-Hill 1996:2709-15.
- 3. Teasdale G, Jennett B. Assessment of coma and impaired consciousness. A practical scale. Lancet 1974;13(7872):81-4.
- 4. Kırış T, İş M, İmer M, Güleç İ, Hepgül K, Ünal F, ve ark. Nöroşirürjide Travma Pratiği, Prospektif Epidemiyolojik Çalışma. Ulus Travma Derg 1998;4(4):281-4.
- 5. Schutzman SA, Barnes P, Duhaime AC, Greenes D, Homer C, Jaffe D, et al. Evaluation and management of children younger than two years old with apparently minor head trauma: proposed guidelines. Pediatrics 2001;107(5):983-93.
- 6. Tsai WC, Chiu WT, Chiou HY, Choy CS, Hung CC, Tsai SH. Pediatric traumatic brain injuries in Taiwan: an 8-year study. J Clin Neurosci 2004;11(2): 126-9.
- 7. Bostancı İ, Sarıoğlu A, Cinbiş M, Bedir E, Herek Ö, Akşit MA. Çocuk acil servise kabul edilen travma olgularının epidemiyolojik değerlendirilmesi. Ulus Travma Derg 1998;4(4):261-4.
- 8. Murgio A, Patrick PD, Andrade FA, Boetto S, Leung KM, Munoz Sanchez MA. International study of emergency department care for pediatric traumatic brain injury and the role of CT scanning. Childs Nerv Syst 2001;17(4-5):257-2.
- 9. Haydel MJ, Preston CA, Mills TJ, Luber S, Blaudeau E, De Blieux PM. Indications for computed tomography in patients with minor head injury. N Engl J Med 2000; 343(2):100-5.
- 10. Rosman NP. Acute Head Trauma. In McMillan JA, Feigin RD, DeAngelis C, Jones MD (Eds). Oski’s Pediatrics, Principles & Practices. Fourth Edition. Lippincott Williams & Wilkins, Philadelphia 2006;730-46.
- 11. 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(9696):1160-70.
- 12. Park SH, Cho BM, Oh SM. Head injuries from falls in preschool children. Yonsei Med J 2004;45(2):229-32.
- 13. Çırak B, Berker M, Özcan OE, Özgen T. Kafa Travmalarının Etken ve Sonuçlarına Bir Bakış: Epidemiyolojik Bir Çalışma. Ulus Travma Derg 1999;5(2):90-2.
- 14. Stiell IG, Wells GA, Vandemheen K, Laupacis A, Brison R, Eisenhover MA. Variation in ED use of computed tomography for patients with minor head injury. Ann Emerg Med 1997;30(1):14-22.
- 15. Young A, Willatts S. Controversies in management of acute brain trauma. Lancet 1998;352(9123):164-6.
- 16. McLaurin RL, Towbin R. Diagnosis and treatment of head injury in infants and children. In: Youmans JR ed. Neurological Surgery. 3rd ed. Philadelphia: W.B. Saunders Co 1990;2149-93.
- 17. Klig JE, Kaplan CP. Minor head injury in children. Curr Opin Pediatr 2010;22(3):257–61.
Öz
Amaç: Kafa travması çocuk acil polikliniğine en sık başvuru sebeplerinden birisidir. Bunların büyük bir
kısmını minör kafa travmaları oluşturmaktadır. Bu çalışmada künt kafa travması ile çocuk acil polikliniğine
başvuran hastaların demografik özellikleri, klinik bulguları ve bilgisayarlı beyin tomografisi (BBT) bulguları
incelenmiş, bu grup hastaların izlem ve değerlendirilmesinde BBT’nin yeri sorgulanmıştır.
Olgular ve Yöntem: Kafa travması ile Ocak 2007 - Ocak 2009 tarihleri arasında çocuk acil polikliniğine
başvurup BBT çekilen 200 hasta yaş, cinsiyet, travma şekli, muayene bulguları ve eşlik eden sistemik
hastalıkları yönünden retrospektif olarak incelendi. Dosya bilgilerinin eksikliği nedeniyle iki hasta çalışma
dışı bırakıldı.
Bulgular: Glaskow koma skalası’na (GKS) göre hastaların % 99.5 (197) hafif (GKS:13-15), %0.5 (1)’i ağır
kafa travmasıydı (GKS: 5). Bir hastada Von Willebrand faktör eksikliği vardı. Hastaların büyük çoğunluğunu
ev içi kaza maruziyeti oluşturmakla beraber ağır kafa travmalı olan bir hasta yüksekten düşmüştü. BBT
çekilen 197 minör kafa travmalı hastanın altı tanesinde lineer kırık tesbit edilirken, bunların bir tanesinde 2
mm’lik epidural hematom vardı. Ağır kafa travmalı bir hastada ise fraktür, multipl kontüzyonlar ve biri 3 mm
diğeri 5 mm olmak üzere iki adet epidural hematom görüldü. BBT çekilen hastaların tümünde saçlı deri ve/
veya yüz bölgesinde laserasyon ve/veya hematom mevcuttu.
Sonuç: Minör kafa travmalarında BBT çekilmesi oranındaki yükseklik dikkat çekici bulundu. BBT çekilen
tüm hastalarda eşlik eden laserasyon ve/ veya hematomun aile üzerinde oluşturduğu endişenin hekimi yanlış
yönlendirdiği düşünüldü. Minör travmaların çocukluk dönemindeki sıklığı ve her travmada çekilen BBT ile
olan radyasyon maruziyeti göz önüne alındığında, gelişmiş görüntüleme yöntemlerine rağmen klinik izlem ve
nörolojik muayene ilk sıradaki önemini korumaktadır.
Anahtar Kelimeler
Kaynakça
- 1. Atabaki SM. Pediatric head injury. Pediatr Rev 2007;28(6):215-24.
- 2. Derek AB. Pediatric head injury. In: Wilkins RH, Rengachary SS, eds. Neurosurgery. 2nd ed. New York: McGraw-Hill 1996:2709-15.
- 3. Teasdale G, Jennett B. Assessment of coma and impaired consciousness. A practical scale. Lancet 1974;13(7872):81-4.
- 4. Kırış T, İş M, İmer M, Güleç İ, Hepgül K, Ünal F, ve ark. Nöroşirürjide Travma Pratiği, Prospektif Epidemiyolojik Çalışma. Ulus Travma Derg 1998;4(4):281-4.
- 5. Schutzman SA, Barnes P, Duhaime AC, Greenes D, Homer C, Jaffe D, et al. Evaluation and management of children younger than two years old with apparently minor head trauma: proposed guidelines. Pediatrics 2001;107(5):983-93.
- 6. Tsai WC, Chiu WT, Chiou HY, Choy CS, Hung CC, Tsai SH. Pediatric traumatic brain injuries in Taiwan: an 8-year study. J Clin Neurosci 2004;11(2): 126-9.
- 7. Bostancı İ, Sarıoğlu A, Cinbiş M, Bedir E, Herek Ö, Akşit MA. Çocuk acil servise kabul edilen travma olgularının epidemiyolojik değerlendirilmesi. Ulus Travma Derg 1998;4(4):261-4.
- 8. Murgio A, Patrick PD, Andrade FA, Boetto S, Leung KM, Munoz Sanchez MA. International study of emergency department care for pediatric traumatic brain injury and the role of CT scanning. Childs Nerv Syst 2001;17(4-5):257-2.
- 9. Haydel MJ, Preston CA, Mills TJ, Luber S, Blaudeau E, De Blieux PM. Indications for computed tomography in patients with minor head injury. N Engl J Med 2000; 343(2):100-5.
- 10. Rosman NP. Acute Head Trauma. In McMillan JA, Feigin RD, DeAngelis C, Jones MD (Eds). Oski’s Pediatrics, Principles & Practices. Fourth Edition. Lippincott Williams & Wilkins, Philadelphia 2006;730-46.
- 11. 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(9696):1160-70.
- 12. Park SH, Cho BM, Oh SM. Head injuries from falls in preschool children. Yonsei Med J 2004;45(2):229-32.
- 13. Çırak B, Berker M, Özcan OE, Özgen T. Kafa Travmalarının Etken ve Sonuçlarına Bir Bakış: Epidemiyolojik Bir Çalışma. Ulus Travma Derg 1999;5(2):90-2.
- 14. Stiell IG, Wells GA, Vandemheen K, Laupacis A, Brison R, Eisenhover MA. Variation in ED use of computed tomography for patients with minor head injury. Ann Emerg Med 1997;30(1):14-22.
- 15. Young A, Willatts S. Controversies in management of acute brain trauma. Lancet 1998;352(9123):164-6.
- 16. McLaurin RL, Towbin R. Diagnosis and treatment of head injury in infants and children. In: Youmans JR ed. Neurological Surgery. 3rd ed. Philadelphia: W.B. Saunders Co 1990;2149-93.
- 17. Klig JE, Kaplan CP. Minor head injury in children. Curr Opin Pediatr 2010;22(3):257–61.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Konular | İç Hastalıkları |
| Bölüm | Research Article |
| Yazarlar | |
| Yayımlanma Tarihi | 1 Ağustos 2011 |
| Gönderilme Tarihi | 27 Aralık 2010 |
| Yayımlandığı Sayı | Yıl 2011 Cilt: 5 Sayı: 2 |