Reimaging in pediatric neurotrauma: factors associated with progression of intracranial injury.
OBJECTIVE
The purpose of this study was to characterize the radiologic changes that are seen in the first 24 to 48 hours after head injury and to correlate those changes with clinical findings, to determine which children are at greatest risk for progression of their neurologic injury.


METHODS
The authors identified 104 children (less-than-or-equal17 years of age) who had a second computed tomography (CT) scan of the head within 24 to 48 hours of admission. CT scans were evaluated systematically in a blinded fashion. Mechanism of injury, findings on physical examination, therapeutic measures, and changes in management were recorded from hospital medical records. The 50 children whose second CT scan showed progression of injury were compared with the 54 patients whose intracranial injuries were unchanged or improved on their second CT.


RESULTS
Twenty-six percent of patients (13 of 50) with radiographic progression of injury had an admission Glasgow coma score of 15. Progression of injury was more common, however, in patients with lower Glasgow coma scores, averaging 9 on admission and 10 at the time of the second CT. Progression of injury also was more common if the initial head CT showed 3 or more intracranial injuries, mass effect, intraventricular hemorrhage, or an epidural hematoma.


CONCLUSIONS
Children with an intracranial injury identified on their initial head CT scan should undergo a second scan 24 hours after injury, especially if the initial CT shows 3 or more intracranial injuries, mass effect, intraventricular hemorrhage, or an epidural hematoma. .
Givner
Andy
A
Department of Surgery, Walter Reed Army Hospital, Division of Neuroradiology Surgery, Boston University School of Medicine, Boston, MA, USA.
Gurney
Jennifer
J
O'Connor
Daniel
D
Kassarjian
Ara
A
Lamorte
Wayne W
WW
Moulton
Steve
S
D000293:Adolescent; D020202:Cerebral Hemorrhage, Traumatic / Q000175:diagnosis / Q000209:etiology / Q000601:surgery; D002648:Child; D020209:Cranial Nerve Injuries / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery; D006259:Craniocerebral Trauma / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D005260:Female; D015600:Glasgow Coma Scale; D016489:Head Injuries, Closed / Q000175:diagnosis* / Q000601:surgery; D020197:Head Injuries, Penetrating / Q000175:diagnosis* / Q000601:surgery; D006407:Hematoma, Epidural, Cranial / Q000175:diagnosis / Q000209:etiology / Q000601:surgery; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D011379:Prognosis; D011446:Prospective Studies; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods