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

Authors

  • Joana Matias Serviço de Pediatria. Hospital Garcia de Orta. Almada. Portugal.
  • Sofia Almeida Departamento de Pediatria. Hospital de Santa Maria. Centro Hospitalar de Lisboa Norte. Lisboa. Portugal.
  • Sofia Ferrito Serviço de Pediatria. Hospital Garcia de Orta. Almada. Portugal.
  • Ana Margarida Queiroz Serviço de Pediatria. Hospital Garcia de Orta. Almada. Portugal.
  • Ana Dias Alves Serviço de Pediatria. Hospital dos Lusíadas. Lisboa. Portugal.
  • Ana Tavares Serviço de Pediatria. Hospital de Cascais Dr. José de Almeida. Cascais. Portugal.
  • Andreia Amorim Serviço de Neurocirurgia. Hospital Garcia de Orta. Almada. Portugal.
  • Paulo Calhau Serviço de Pediatria. Hospital Garcia de Orta. Almada. Portugal.
  • Isabel Saraiva de Melo Serviço de Pediatria. Hospital Garcia de Orta. Almada. Portugal.

DOI:

https://doi.org/10.20344/amp.8795

Keywords:

Brain Injuries/diagnostic imaging, Child, Craniocerebral Trauma, Tomography, X-Ray Computed

Abstract

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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Published

2017-10-31

How to Cite

1.
Matias J, Almeida S, Ferrito S, Queiroz AM, Dias Alves A, Tavares A, Amorim A, Calhau P, Saraiva de Melo I. The Experience of a Protocol for the Management of Pediatric Minor Head Injury: A Three Years Longitudinal Study. Acta Med Port [Internet]. 2017 Oct. 31 [cited 2023 Feb. 7];30(10):704-12. Available from: https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/8795

Issue

Section

Original