Celine Alicia Franco-Koehrlen1, José Iglesias-Leboreiro2, Isabel Bernárdez-Zapata3, Mario Enrique Rendón-Macías4. 1. Hospital Español de México; Facultad Mexicana de Medicina Universidad La Salle, México D.F., México. Electronic address: linefra@hotmail.com. 2. Unidad de Cuidados Intensivos e Intermedios Neonatales, Hospital Español de México, México D.F., México. 3. Cunero Fisiológico, Hospital Español de México, México D.F., México. 4. Unidad de Investigación Médica en Epidemiología Clínica, Hospital de Pediatría, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, México D.F., México.
Abstract
BACKGROUND: The main goal of this article was to evaluate if the decision to perform cranial computed tomography (CT) in children with minor head injury is determined by the presence or absence of the physician during assessment in the emergency room. METHODS: Clinical files of 92 patients from 8 months to 4 years of age were selected. Those children were evaluated at the emergency department of the Spanish Hospital of Mexico due to non-severe traumatic brain injury. Glasgow Coma Scale (GCS) score was determined in all patients. Groups of patients were compared: 1) patients having CT, 2) patients with a physician who attended the initial assessment, 3) patients whose attending physician did not arrive to assess the patient and 4) patients assessed by the emergency room staff. RESULTS: 38% of patients with non-severe brain injury underwent CT, 8.6% had a brain injury visible on the CT. Moderate intensity impacts were greater in patients with CT. Regarding the ECG, it was found that most children scored 15 points (p=0.03). In patients without a physician, a greater trend was demonstrated for performing CT. CONCLUSIONS: Patients with minor head injury but without neurological signs should undergo a detailed clinical evaluation in order to avoid unwarranted CT.
BACKGROUND: The main goal of this article was to evaluate if the decision to perform cranial computed tomography (CT) in children with minor head injury is determined by the presence or absence of the physician during assessment in the emergency room. METHODS: Clinical files of 92 patients from 8 months to 4 years of age were selected. Those children were evaluated at the emergency department of the Spanish Hospital of Mexico due to non-severe traumatic brain injury. Glasgow Coma Scale (GCS) score was determined in all patients. Groups of patients were compared: 1) patients having CT, 2) patients with a physician who attended the initial assessment, 3) patients whose attending physician did not arrive to assess the patient and 4) patients assessed by the emergency room staff. RESULTS: 38% of patients with non-severe brain injury underwent CT, 8.6% had a brain injury visible on the CT. Moderate intensity impacts were greater in patients with CT. Regarding the ECG, it was found that most children scored 15 points (p=0.03). In patients without a physician, a greater trend was demonstrated for performing CT. CONCLUSIONS:Patients with minor head injury but without neurological signs should undergo a detailed clinical evaluation in order to avoid unwarranted CT.