The Experience of a Protocol for the Management of Pediatric Minor Head Injury: A Three Years Longitudinal Study

Detalhes bibliográficos
Autor(a) principal: Matias, Joana
Data de Publicação: 2017
Outros Autores: Almeida, Sofia, Ferrito, Sofia, Queiroz, Ana Margarida, Dias Alves, Ana, Tavares, Ana, Amorim, Andreia, Calhau, Paulo, Saraiva de Melo, Isabel
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.
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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
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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
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