Value of Repeat Cranial Computed Tomography in Pediatric Patients Sustaining Moderate to Severe Traumatic Brain Injury

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dc.contributor.authorLucas da Silva, Paulo Sergio
dc.contributor.authorReis, Maria Eunice
dc.contributor.authorAguiar, Vania Euzebio
dc.contributor.institutionUniversidade Federal de São Paulo (UNIFESP)
dc.date.accessioned2016-01-24T13:51:57Z
dc.date.available2016-01-24T13:51:57Z
dc.date.issued2008-12-01
dc.description.abstractBackground: 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 (lay 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-tip 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.Conclusion: 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.en
dc.description.affiliationHosp Servidor Publ Municipal, Dept Pediat, Pediat Intens Care Unit, São Paulo, Brazil
dc.description.sourceWeb of Science
dc.format.extent1293-1297
dc.identifierhttp://dx.doi.org/10.1097/TA.0b013e318156866c
dc.identifier.citationJournal of Trauma-injury Infection and Critical Care. Philadelphia: Lippincott Williams & Wilkins, v. 65, n. 6, p. 1293-1297, 2008.
dc.identifier.doi10.1097/TA.0b013e318156866c
dc.identifier.issn0022-5282
dc.identifier.urihttp://repositorio.unifesp.br/handle/11600/31087
dc.identifier.wosWOS:000261706000019
dc.language.isoeng
dc.publisherLippincott Williams & Wilkins
dc.relation.ispartofJournal of Trauma-injury Infection and Critical Care
dc.rightsinfo:eu-repo/semantics/restrictedAccess
dc.subjectChildrenen
dc.subjectCT scanen
dc.subjectTraumatic brain injuryen
dc.subjectGlasgow Coma Scaleen
dc.subjectPediatric intensive care uniten
dc.titleValue of Repeat Cranial Computed Tomography in Pediatric Patients Sustaining Moderate to Severe Traumatic Brain Injuryen
dc.typeinfo:eu-repo/semantics/article
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