Original Paper

Indications for Brain Computed Tomography and Hospital Admission in Pediatric Patients with Minor Head Injury: How Much Can We Rely upon Clinical Findings?
Ahmet Güzel^a, Tufan Hiçdönmez^b, Osman Temizöz^c, Burhan Aksu^d, Hakan Aylanç^a, Serap Karasalihoglu^a

Departments of
^aPediatrics,
^bNeurosurgery,
^cRadiology and
^dPediatric Surgery, Trakya University Faculty of Medicine, Edirne, Turkey

Address of Corresponding Author

Pediatr Neurosurg 2009;45:262-270 (DOI: 10.1159/000228984)

  Key Words

• Head injury
• Computed tomography
• Trauma
• Pediatric
• Risk factors
• Hospital admission

  Abstract

Objectives: The aim of this study was to describe the characteristics of patients with a minor head injury (MHI) who were admitted to a pediatric emergency unit and to identify the clinical signs and symptoms that most reliably predict the need for cranial computed tomography (CCT) and hospital admission following MHI. Methods: All patients were retrospectively evaluated according to age, gender, details of injury, presenting symptoms, physical examination findings, radiological investigations ordered and results, length of stay, outcome of the injury and hospitalization rates. Results: The factors affecting indications for computed tomography and hospitalization were retrospectively analyzed in 916 patients - 585 males and 331 females, aged between 1 month and 15 years (mean: 5.01 ± 3.58 years), with MHI. A multivariate analysis revealed significant correlations between CCT abnormalities and Glasgow Coma Scale scores of 13 or 14, headache, posttraumatic amnesia, blurred vision, cephalohematomas, periorbital ecchymoses, otorrhea and abnormal neurological findings. CCT abnormalities were identified in 67 (19.8%) of the 338 CCT scans. Twenty of the 67 patients (29.9%) with CCT scan abnormality had no clinical signs. Of all cases, 125 (13.6%) were hospitalized, 617 (67.4%) were treated as outpatients, and 174 (19.0%) left the emergency department based on a personal decision. Conclusion: Some clinical risk factors can be used as predictors of abnormalities in CCT scans following MHI, but the absence of such clinical findings does not exclude the possibility of intracranial injuries.

Copyright © 2009 S. Karger AG, Basel

  Author Contacts

Ahmet Güzel
Trakya University Faculty of Medicine
Department of Pediatrics
TR-22030 Edirne (Turkey)
Tel. +90 284 235 76 41, Fax +90 284 235 23 38, E-Mail ahmetgzl@yahoo.com

  Article Information

Received: August 13, 2008
Accepted after revision: April 19, 2009
Published online: July 17, 2009
Number of Print Pages : 9
Number of Figures : 2, Number of Tables : 7, Number of References : 36