U. Tabori et al., Repeat computed tomographic scan within 24-48 hours of admission in children with moderate and severe head trauma, CRIT CARE M, 28(3), 2000, pp. 840-844
Objective: To asses the yield and contribution of a routine predetermined r
epeat head computed tomographic (CT) scan within 24-36 hrs in pediatric pat
ients with moderate to severe head trauma.
Design: Records review.
Setting: Five pediatric intensive care units.
Patients: We reviewed the charts of 173 consecutive pediatric patients with
moderate to severe head trauma (Glasgow Coma Scale score of less than or e
qual to 11) that survived the first 24 hrs after being admitted to five Isr
aeli trauma centers. Clinical data collected included status at admission,
at the time between the first and second CT scans, and after the second sca
n. Head details of the first, second, and, if performed, third CT scan were
collected. Treatment strategy during each period was recorded, including a
ny change in treatment after each CT scan.
Measurements and Main Results:A total of 47 (27%) of the second CT scans sh
owed new lesions including six intracranial hemorrhages, 17 cases of worsen
ing brain edema, and 18 newly diagnosed brain contusions. However, none of
these findings necessitated surgical intervention or any change in therapy.
Of the 67 patients who underwent a third CT scan, two cases required surgi
cal intervention because of new findings in the third CT.
Conclusions: A second routine prescheduled head GT scan within 24-36 hrs af
ter admission in pediatric patients with moderate to severe head trauma is
unlikely to yield any change in therapy. Clinically and intracranial pressu
re-oriented CT scan may better select and diagnose patients who require cha
nges in therapy, including surgery. Studies aimed to determine the ideal ti
ming for the second are warranted.