Mild and moderate pediatric traumatic brain injury: replace routine repeat head computed tomography with neurologic examination.
BACKGROUND
Opinion is divided on the role of routine repeat head computed tomography (RHCT) for guiding clinical management in pediatric patients with blunt head trauma. We hypothesize that routine RHCT does not lead to change in management in mild and moderate traumatic brain injury (TBI).


METHODS
This is a 3-year retrospective study of all patients of age 2 years to 18 years with blunt TBI admitted to our Level 1 trauma center with an abnormal head CT. Indications for RHCT (routine vs. neurologic deterioration) and their findings (progression or improvement) were recorded. Neurosurgical intervention was defined as extraventricular drain placement, craniectomy, or craniotomy. Primary outcome was a change in management after RHCT.


RESULTS
A total of 291 pediatric patients were identified; of which 191 patients received an RHCT. Routine RHCT did not lead to neurosurgical intervention in the mild and moderate TBI group. In patients who received RHCT due to neurologic decline (n = 7), radiographic progression was seen on 85% of the patients (n = 6), with subsequent neurosurgical interventions in three patients. Two of these patients had a Glasgow Coma Scale (GCS) score of less than 8 at admission.


CONCLUSIONS
Our study showed that the neurologic examination can be trusted and is reliable in pediatric blunt TBI patients in determining when an RHCT scan is necessary. We recommend that RHCT is required routinely in patients with intracranial hemorrhage with GCS score of 8 or less and in patients with GCS greater than 8 and that RHCT be performed only when there are clinical indications.


METHODS
Diagnostic/therapeutic study, level IV.
From the Division of Trauma, Department of Surgery, University of Arizona, Tucson, Arizona.
Hassan
H
Aziz
Peter
P
Rhee
Viraj
V
Pandit
Irada
I
Ibrahim-Zada
Narong
N
Kulvatunyou
Julie
J
Wynne
Bardiya
B
Zangbar
Terence
T
O'Keeffe
Andrew
A
Tang
Randall S
RS
Friese
Bellal
B
Joseph
D000293:Adolescent; D001930:Brain Injuries / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D003399:Craniotomy; D056424:Decompressive Craniectomy; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D009460:Neurologic Examination; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D014949:Wounds, Nonpenetrating / Q000175:diagnosis / Q000000981:diagnostic imaging