Anıl ER, Aykut ÇAĞLAR, Emel ULUSOY, Murat DUMAN, Fatma AKGÜL, Durgül YILMAZ

Hafif Travmatik Beyin Yaralanması olan Çocuklarda Rutin Olarak Çekilen İkinci Bilgisayarlı Beyin Tomografisinin Radyolojik ve Klinik Sonuçları

Amaç: Bu çalışmada ilk bilgisayarlı beyin tomografisinde (BBT) hafif travmatik beyin yaralanması (TBY) olan çocuklarda rutin olarak çekilen ikinci BBT’nin tedavi yaklaşımına katkısını değerlendirmek amaçlanmıştır. Yöntem: Retrospektif çalışmamız Ağustos 2010—Ağustos 2014 döneminde pediyatrik acil servisimizde hafif TBY’li çocuklar arasından ilk BBT’sinde travmatik lezyon görülen ve rutin olarak ikinci kez BBT çekilen hastalarla gerçekleştirildi. Hasta verileri (yaş ve cinsiyet, travma mekanizması, belirtiler, fizik muayene bulguları, ilk ve ikinci BBT bulguları, iki BBT arasındaki süre, medikal ve cerrahi tedaviler) kaydedildi. Bulgular: Çalışma, dahil edilme kriterlerini sağlayan ve %57,5’i erkek olan toplam 113 hasta içerdi. Ortanca hasta yaşı 28 (çeyrekler arası aralık: 6,5–80) ay idi. Hastaların 72’si (%63,7) hastaneye kabul sırasında asemptomatikti ve 54 (%47,8) hastada bir fizik muayene bulgusu yoktu. Travmatik lezyonların %64,9’u lineer kafatası fraktürü, %13,7’si subdural hematom, %13’ü kontüzyon, %3,8’i subaraknoid kanama, %3’ü epidural hematom, %0,8’i intraparankimal kanama, %0,8’i çökme fraktürü idi. Rutin ikinci BBT 11±2,5 saat sonra çekilmiş ve hastaların %6,2’sinde ilerleme ortaya koymuştu. Sonrasında medikal ya da nörocerrahi tedavide bir değişiklik olmamıştı. Sonuç: Acil servisimizde rutin olarak tekrarlanan BBT’de ilerleme oranı %6,2 olmakla birlikte uygulanan medikal ve nörocerrahi tedavilerde bir değişiklik olmamıştır.

The Radiological and Clinical Outcomes of Routinely Performed Second Head Computed Tomography in Children with Mild Traumatic Brain Injury

Aim: In this study, we aimed to assess how the routine use of a second head computed tomography (CT) scan contributed to therapeutic approach in children diagnosed with mild traumatic brain injury (TBI). Methods: The retrospective study included children with mild TBI who had traumatic lesions on initial head CT and underwent a second CT scan as performed routinely at our pediatric emergency department between August 2010 and August 2014. Patient data (age and sex, mechanism of trauma, symptoms, physical examination findings, results of the first and second head CT scans, time between the two scans, and medical and surgical treatments) were recorded. Results: A total of 113 patients met the inclusion criteria and 57.5% of them were male. The median patient age was 28 (interquartile range: 6.5–80) months. Seventy-two (63.7%) patients were asymptomatic on admission and there was no finding on physical examination in 54 (47.8%) patients. Of all traumatic lesions, 64.9% were linear skull fracture, 13.7% subdural hematoma, 13% contusion, 3.8% subarachnoid hemorrhage, 3% epidural hematoma, 0.8% intraparenchymal hemorrhage, and 0.8% depressed skull fracture. The routine second head CT scans were performed after 11±2.5 hours and revealed progression in 6.2% of the patients. No subsequent change in medical treatment or neurosurgical intervention occurred. Conclusion: Although the progression rate in routinely repeated CT at our emergency department was 6.2%, there was no change in the medical and neurosurgical interventions performed.

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