Value of repeat cranial computed tomography in pediatric patients sustaining moderate to severe traumatic brain injury.
BACKGROUND
Repeat head computed tomography (CT) is standard practice for traumatic brain injury (TBI) at many centers. The few studies available in children remain unclear over the value of repeat CT within 24 hours to 48 hours of lesion in such patients. The purpose of the present study was to assess the value of repeat cranial CT in children presenting moderate or severe TBI.


METHODS
A retrospective study performed within a pediatric intensive care unit between January 2000 and December 2006. All patients with moderate and severe TBI who survived the first 24 hours after admission were included. Clinical data collected included age, lesion mechanism, time between first and second CTs, disease severity score at admission, and Glasgow Coma Scale (GCS) both at admission and day of repeat CT.


RESULTS
A total of 63 children were assessed whose mean age was 72 months (48-112). The time between the first and the second CT scans averaged 25.78 hours +/- 13.75 hours (range, 6-48 hours). The reasons for ordering repeat CT scans were divided as follows: follow-up (78%), neurologic deterioration (20.4%), and increased intracranial pressure (1.6%). The change on the follow-up CT scan was compared with the GCS score. The GCS score was improved in 66.6% of patients, remained the same in 15.9%, and worsened in 17.5%. The appearance on the CT scans was better, the same or worse in 41.3%, 34.9%, and 23.8% of patients, respectively. There was a significant association between GCS and changes in findings on repeat CT (OR = 34.5, confidence interval [5.98-199.04], p = 0.000009). The positive and negative predictive values were 82% and 89%, respectively. One patient with a worsened GCS required surgical intervention based on the repeat CT scan.


CONCLUSIONS
An unchanged or improving neurologic examination in children sustaining moderate or severe TBI who are appropriately monitored may be adequate to exclude the possibility of neurosurgical intervention and, hence, repeat head CT scan.
da Silva
Paulo Sérgio Lucas
PS
Pediatric Intensive Care Unit, Department of Pediatrics, Hospital do Servidor Público Municipal, São Paulo, Brazil. psls.nat@terra.com.br
Reis
Maria Eunice
ME
Aguiar
Vânia Euzébio
VE
D000293:Adolescent; D001930:Brain Injuries / Q000000981:diagnostic imaging* / Q000401:mortality / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D020833:Diffuse Axonal Injury / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D015600:Glasgow Coma Scale; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric; D020198:Intracranial Hemorrhage, Traumatic / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery; D019586:Intracranial Hypertension / Q000000981:diagnostic imaging; D008297:Male; D009460:Neurologic Examination; D012189:Retrospective Studies; D015996:Survival Rate; D014057:Tomography, X-Ray Computed