Mustafa BOĞAN, Hasan Baki ALTINSOY, Murat OKTAY

Acil serviste tespit edilen çocukluk çağı kafa tası kırıklarının mortalite ve morbiditesinin incelenmesi

Amaç: Kafatası kırıkları çocukluk çağında sık görülen yaralanmalardandır, basit travmalarla oluşan izole lineer kırıklardan yüksek enerjili travmalara oluşan intrakraniyal kanamayı da içeren çökme kırıklarına kadar değişen derecelerde görülebilmektedir. Bu çalışmanın amacı kafa travması sonrası acil servise başvuran, 16 yaş ve altı çocuklarda tespit edilen kafatası kırıklarının mortalite ve morbiditesini araştırmaktır. Materyal ve Metot: Kafatası kırığı nedeniyle travma ünitesine alınan 16 yaş ve altı çocuk hastalar çalışmaya dahil edilmiştir. Bulgular: Hastaların (toplam 113 vaka) yaş ortalaması 4,163,71 (0-15), %64,6’sı erkek ve geliş nedenleri en sık yüksekten düşmeydi (%69). Kafatası kırığı en sık sağ tarafta (%54), en sık frontal kemikte (%31) ve en sık lineer kırık (%78,8) izlenmiştir. Hastaların %68,1’inde kırığa eşlik eden intrakraniyal kanama izlenmemiştir. Travma ünitesinde takibe alınan hastaların ortalama yatış süreleri 3,424,52 (0-25) gündüz, 53 hastaya (%46,9) kontrol bilgisayarlı beyin tomografisi (BBT) çekilmiş, bunlardan 24(%45,3)’ünde kontrol BBT’de yeni gelişen intrakraniyal patoloji (6 hastada yeni gelişen kanama, 10 hastadan mevcut kanamda artış, 3 hastada yeni gelişen ödem, 4 hastada mevcut ödemde artış, bir hastada orta hat yapılarında yeni gelişen şift) izlenmiştir. 4 hasta nöroşirürjik operasyona alınırken, mortalite izlenmemiştir. Sonuç: Çocukluk çağı kafa travmalarında radyolojik görüntülemede fraktür izlense dahi mortalite ve cerrahi oranları düşüktür. Ancak düşük GKS, deplase fraktür (çökme kırığı gibi) ve kırıkla birlikte olan kanamalar cerrahiye gidişi artırabilmektedir.

Anahtar Kelimeler:

kafa travması;, kafa tası kırığı;, çocukluk çağı;

Investigation of mortality and morbidity of childhood skull fractures detected in the emergency department

Objective: Skull fractures are common injuries in childhood, and it can be seen in varying degrees, ranging from simple traumas (such as falling from a parent's bed to a hard floor), isolated linear fractures, to high-energy traumas (such as falling from height, assault, traffic accident) and intracranial hemorrhage. The aim of this study is to investigate the mortality and morbidity of skull fractures detected in children under 16 years of age who applied to the emergency room after head trauma. Material and Methods: Patients aged 16 and under who were taken to the trauma unit due to skull fracture were included in the study. Results: The mean age of the patients (total of 113 cases) was 4.163.71 (0-15), 64.6% of them were male, and the reasons for their arrival were most frequently not falling from height (69%). The skull fracture was observed most frequently on the right side (54%), most often in the frontal bone (31%) and most frequently in the linear fracture (78.8%). In 68.1 % of patients, intracranial bleeding accompanying the fracture was not observed. The average length of hospitalization of patients who were followed-up in the trauma unit was 3.424.52 (0-25) during the day, 53 patients (46.9%) received control CCT, and 24 (45.3%) of them developed new control CCT. Intracranial pathology (new bleeding in 6 patients, increase in existing bleeding from 10 patients, newly developing edema in 3 patients, increase in existing edema in 4 patients, newly developing shift in midline structures in one patient). While 4 patients were taken to the neurosurgical operation, no mortality was observed. Conclusion: Mortality and operation rates are low in childhood head trauma, even if fractures are observed in radiological imaging. However, low GCS, displaced fracture (such as collapse fracture) and bleeding associated with the fracture can increase the rate of surgery.

Keywords:

head injury;, skull fracture;, childhood,

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