The Experience of a Protocol for the Management of Pediatric Minor Head Injury: A Three Years Longitudinal Study
Autor(a) principal: | |
---|---|
Data de Publicação: | 2017 |
Outros Autores: | , , , , , , , |
Tipo de documento: | Artigo |
Idioma: | por eng |
Título da fonte: | Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
Texto Completo: | https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/8795 |
Resumo: | Introduction: Head injury is common in children, with mostly being minor and not resulting in intracranial injury. Computerized tomography head scan is the preferred exam, but implies exposure to radiation; the indications for computerized tomography head scan in minor injuries are not consensual. An expectant approach is a good option in most cases. The aim was to compare the patients hospitalized and subjected to computerized tomography head scan with patients hospitalized but not subjected to computerized tomography head scan in order to assess the safety of our institution’s practice protocol.Material and Methods: Analytical longitudinal retrospective study, during three years, including patients younger than 15 years of age with minor head injury, admitted for in hospital surveillance through a paediatric emergency room. We defined two study groups: group A (hospitalized with computerized tomography head scan) and group B (hospitalized without computerized tomography head scan).Results: Study sample consisting of 206 patients: 81 (39%) group A and 125 (61%) group B. Symptoms, including vomiting, were more frequent in group B (91% and 61% vs 75% and 35%, p < 0.05); large scalp hematoma and palpable fracture in group A (11% and 12% vs 0%, p < 0.05). We performed computerized tomography head scan in 39% of the study patients (children with red flags in the physical examination or unfavourable course during hospitalization); 43% had traumatic brain injury (29 patients had fracture, 18 patients had intracranial injury). Three patients underwent neurosurgery. We did not register deaths, readmissions or neurologic sequelae.Discussion: Significant intracranial injury was infrequent. The hospitalization and surveillance of children and adolescents with symptomatic minor head injury, without red flags in the physical examination, did not seem to result in additional risks.Conclusion: The careful selection of patients for computerized tomography head scan enabled a decrease in the number of these exams and the exposure to ionizing radiation. |
id |
RCAP_87638ff6cbd848b6223a6cf53fd80845 |
---|---|
oai_identifier_str |
oai:ojs.www.actamedicaportuguesa.com:article/8795 |
network_acronym_str |
RCAP |
network_name_str |
Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
repository_id_str |
7160 |
spelling |
The Experience of a Protocol for the Management of Pediatric Minor Head Injury: A Three Years Longitudinal StudyA Experiência duma Norma de Atuação no Traumatismo Crânio-Encefálico Ligeiro em Idade Pediátrica: Estudo Longitudinal de Três AnosBrain Injuries/diagnostic imagingChildCraniocerebral TraumaTomographyX-Ray ComputedCriançaLesões Encefálicas/diagnóstico por imagemTomografia ComputorizadaTraumatismos CraniocerebraisIntroduction: Head injury is common in children, with mostly being minor and not resulting in intracranial injury. Computerized tomography head scan is the preferred exam, but implies exposure to radiation; the indications for computerized tomography head scan in minor injuries are not consensual. An expectant approach is a good option in most cases. The aim was to compare the patients hospitalized and subjected to computerized tomography head scan with patients hospitalized but not subjected to computerized tomography head scan in order to assess the safety of our institution’s practice protocol.Material and Methods: Analytical longitudinal retrospective study, during three years, including patients younger than 15 years of age with minor head injury, admitted for in hospital surveillance through a paediatric emergency room. We defined two study groups: group A (hospitalized with computerized tomography head scan) and group B (hospitalized without computerized tomography head scan).Results: Study sample consisting of 206 patients: 81 (39%) group A and 125 (61%) group B. Symptoms, including vomiting, were more frequent in group B (91% and 61% vs 75% and 35%, p < 0.05); large scalp hematoma and palpable fracture in group A (11% and 12% vs 0%, p < 0.05). We performed computerized tomography head scan in 39% of the study patients (children with red flags in the physical examination or unfavourable course during hospitalization); 43% had traumatic brain injury (29 patients had fracture, 18 patients had intracranial injury). Three patients underwent neurosurgery. We did not register deaths, readmissions or neurologic sequelae.Discussion: Significant intracranial injury was infrequent. The hospitalization and surveillance of children and adolescents with symptomatic minor head injury, without red flags in the physical examination, did not seem to result in additional risks.Conclusion: The careful selection of patients for computerized tomography head scan enabled a decrease in the number of these exams and the exposure to ionizing radiation.Introdução: Os traumatismos crânio-encefálicos são frequentes em Pediatria, habitualmente ligeiros e sem lesões intracranianas. A tomografia computorizada crânio-encefálica é o exame de eleição, implicando radiação ionizante, não existindo consenso nas indicações nos traumatismos crânio-encefálicos ligeiros. Uma atitude expectante é uma opção adequada na maioria dos casos. Os autores pretenderam comparar os doentes internados e submetidos a tomografia computorizada crânio-encefálica com os doentes internados sem tomografia computorizada crânio-encefálica, inferindo a segurança da norma de atuação em vigor na nossa instituição.Material e Métodos: Estudo analítico longitudinal retrospetivo, durante três anos, de doentes com menos de 15 anos admitidos na Urgência Pediátrica e internados por traumatismos crânio-encefálicos ligeiros. Amostra organizada num grupo A (internados com tomografia computorizada crânio-encefálica) e num grupo B (internados sem tomografia computorizada crânio-encefálica).Resultados: Amostra de estudo constituída por 206 doentes: 81 (39%) grupo A e 125 (61%) grupo B. Sintomas, nomeadamente vómitos, foram mais frequentes no grupo B (91% e 61% vs 75% e 35%, p < 0,05); hematoma epicraniano volumoso e afundamento ósseo no grupo A (11% e 12% vs 0%, p < 0,05). Realizou-se tomografia computorizada crânio-encefálica em 39% dos doentes estudados (crianças com sinais de alarme à observação ou evolução não favorável durante o internamento); 43% tinham alterações (29 doentes apresentavam fratura, 18 doentes apresentavam lesões intracranianas). Três doentes foram submetidos a neurocirurgia. Não registámos óbitos, reinternamentos ou sequelas neurológicas.Discussão: As lesões intracranianas clinicamente significativas foram pouco frequentes. A atitude preconizada de vigilância hospitalar das crianças e adolescentes com traumatismos crânio-encefálicos ligeiros sintomáticos, sem alterações significativas ao exame objetivo, não pareceu ter implicado riscos acrescidos.Conclusão: A utilização criteriosa da tomografia computorizada crânio-encefálica permitiu reduzir o número de exames e a exposição a radiação ionizante.Ordem dos Médicos2017-10-31info:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articleapplication/pdfapplication/pdfapplication/pdfapplication/pdfapplication/pdfapplication/pdfhttps://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/8795oai:ojs.www.actamedicaportuguesa.com:article/8795Acta Médica Portuguesa; Vol. 30 No. 10 (2017): October; 704-712Acta Médica Portuguesa; Vol. 30 N.º 10 (2017): Outubro; 704-7121646-07580870-399Xreponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãoinstacron:RCAAPporenghttps://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/8795https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/8795/5203https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/8795/6029https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/8795/9218https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/8795/9319https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/8795/9440https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/8795/9575Direitos de Autor (c) 2017 Acta Médica Portuguesainfo:eu-repo/semantics/openAccessMatias, JoanaAlmeida, SofiaFerrito, SofiaQueiroz, Ana MargaridaDias Alves, AnaTavares, AnaAmorim, AndreiaCalhau, PauloSaraiva de Melo, Isabel2022-12-20T11:05:37Zoai:ojs.www.actamedicaportuguesa.com:article/8795Portal AgregadorONGhttps://www.rcaap.pt/oai/openaireopendoar:71602024-03-19T16:19:38.646667Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãofalse |
dc.title.none.fl_str_mv |
The Experience of a Protocol for the Management of Pediatric Minor Head Injury: A Three Years Longitudinal Study A Experiência duma Norma de Atuação no Traumatismo Crânio-Encefálico Ligeiro em Idade Pediátrica: Estudo Longitudinal de Três Anos |
title |
The Experience of a Protocol for the Management of Pediatric Minor Head Injury: A Three Years Longitudinal Study |
spellingShingle |
The Experience of a Protocol for the Management of Pediatric Minor Head Injury: A Three Years Longitudinal Study Matias, Joana Brain Injuries/diagnostic imaging Child Craniocerebral Trauma Tomography X-Ray Computed Criança Lesões Encefálicas/diagnóstico por imagem Tomografia Computorizada Traumatismos Craniocerebrais |
title_short |
The Experience of a Protocol for the Management of Pediatric Minor Head Injury: A Three Years Longitudinal Study |
title_full |
The Experience of a Protocol for the Management of Pediatric Minor Head Injury: A Three Years Longitudinal Study |
title_fullStr |
The Experience of a Protocol for the Management of Pediatric Minor Head Injury: A Three Years Longitudinal Study |
title_full_unstemmed |
The Experience of a Protocol for the Management of Pediatric Minor Head Injury: A Three Years Longitudinal Study |
title_sort |
The Experience of a Protocol for the Management of Pediatric Minor Head Injury: A Three Years Longitudinal Study |
author |
Matias, Joana |
author_facet |
Matias, Joana Almeida, Sofia Ferrito, Sofia Queiroz, Ana Margarida Dias Alves, Ana Tavares, Ana Amorim, Andreia Calhau, Paulo Saraiva de Melo, Isabel |
author_role |
author |
author2 |
Almeida, Sofia Ferrito, Sofia Queiroz, Ana Margarida Dias Alves, Ana Tavares, Ana Amorim, Andreia Calhau, Paulo Saraiva de Melo, Isabel |
author2_role |
author author author author author author author author |
dc.contributor.author.fl_str_mv |
Matias, Joana Almeida, Sofia Ferrito, Sofia Queiroz, Ana Margarida Dias Alves, Ana Tavares, Ana Amorim, Andreia Calhau, Paulo Saraiva de Melo, Isabel |
dc.subject.por.fl_str_mv |
Brain Injuries/diagnostic imaging Child Craniocerebral Trauma Tomography X-Ray Computed Criança Lesões Encefálicas/diagnóstico por imagem Tomografia Computorizada Traumatismos Craniocerebrais |
topic |
Brain Injuries/diagnostic imaging Child Craniocerebral Trauma Tomography X-Ray Computed Criança Lesões Encefálicas/diagnóstico por imagem Tomografia Computorizada Traumatismos Craniocerebrais |
description |
Introduction: Head injury is common in children, with mostly being minor and not resulting in intracranial injury. Computerized tomography head scan is the preferred exam, but implies exposure to radiation; the indications for computerized tomography head scan in minor injuries are not consensual. An expectant approach is a good option in most cases. The aim was to compare the patients hospitalized and subjected to computerized tomography head scan with patients hospitalized but not subjected to computerized tomography head scan in order to assess the safety of our institution’s practice protocol.Material and Methods: Analytical longitudinal retrospective study, during three years, including patients younger than 15 years of age with minor head injury, admitted for in hospital surveillance through a paediatric emergency room. We defined two study groups: group A (hospitalized with computerized tomography head scan) and group B (hospitalized without computerized tomography head scan).Results: Study sample consisting of 206 patients: 81 (39%) group A and 125 (61%) group B. Symptoms, including vomiting, were more frequent in group B (91% and 61% vs 75% and 35%, p < 0.05); large scalp hematoma and palpable fracture in group A (11% and 12% vs 0%, p < 0.05). We performed computerized tomography head scan in 39% of the study patients (children with red flags in the physical examination or unfavourable course during hospitalization); 43% had traumatic brain injury (29 patients had fracture, 18 patients had intracranial injury). Three patients underwent neurosurgery. We did not register deaths, readmissions or neurologic sequelae.Discussion: Significant intracranial injury was infrequent. The hospitalization and surveillance of children and adolescents with symptomatic minor head injury, without red flags in the physical examination, did not seem to result in additional risks.Conclusion: The careful selection of patients for computerized tomography head scan enabled a decrease in the number of these exams and the exposure to ionizing radiation. |
publishDate |
2017 |
dc.date.none.fl_str_mv |
2017-10-31 |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/8795 oai:ojs.www.actamedicaportuguesa.com:article/8795 |
url |
https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/8795 |
identifier_str_mv |
oai:ojs.www.actamedicaportuguesa.com:article/8795 |
dc.language.iso.fl_str_mv |
por eng |
language |
por eng |
dc.relation.none.fl_str_mv |
https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/8795 https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/8795/5203 https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/8795/6029 https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/8795/9218 https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/8795/9319 https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/8795/9440 https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/8795/9575 |
dc.rights.driver.fl_str_mv |
Direitos de Autor (c) 2017 Acta Médica Portuguesa info:eu-repo/semantics/openAccess |
rights_invalid_str_mv |
Direitos de Autor (c) 2017 Acta Médica Portuguesa |
eu_rights_str_mv |
openAccess |
dc.format.none.fl_str_mv |
application/pdf application/pdf application/pdf application/pdf application/pdf application/pdf |
dc.publisher.none.fl_str_mv |
Ordem dos Médicos |
publisher.none.fl_str_mv |
Ordem dos Médicos |
dc.source.none.fl_str_mv |
Acta Médica Portuguesa; Vol. 30 No. 10 (2017): October; 704-712 Acta Médica Portuguesa; Vol. 30 N.º 10 (2017): Outubro; 704-712 1646-0758 0870-399X reponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação instacron:RCAAP |
instname_str |
Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
instacron_str |
RCAAP |
institution |
RCAAP |
reponame_str |
Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
collection |
Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
repository.name.fl_str_mv |
Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
repository.mail.fl_str_mv |
|
_version_ |
1799130646755409920 |