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Literature Reviews

Severe head trauma in children: cranial computer tomography and clinical consequences.

Hirsch W, Schobeb A, Eichler G, Zumkeller W, Teichler H and Schluter A. Paediatric Anaesthesia 2002 12: 337-344.

The investigators examined the prognostic and therapeutic implications of cranial CT scans in children who suffered closed head injury. This retrospective study of 248 children evaluated the neurologic outcome following closed head injury and examined patterns of abnormal findings on CT correlated with outcomes. If an initial CT scan revealed no abnormality or a single abnormality (e.g. subdural or epidural hematoma), then 100% (172 patients) of the children demonstrated a Glasgow-Liege score of fifteen at one year. More ominous prognosis was associated with multiple or diffuse findings. Of children with generalized edema, 37% died and 25% were left with an impaired level of consciousness at one year. Parenchymal and ventricular hemorrhages were also associated with poor prognosis.

This study is interesting in that it corroborates the effectiveness of surgical therapy in children with mass lesions and the ultimate good outcome. The investigators recognize the limitations of their retrospective study design and their categorization of pathological findings by CT. The more contemporary term `diffuse axonal injury' is introduced as well. Interestingly, the investigators comment on the substantial radiation exposure some of these children might receive from multiple CT scans and they suggest that MRI may reduce this exposure. However, although MRI is more universally available than ten years ago, taking a child for MRI scan who is critically ill is not for the faint of heart. Real mechanical and electromagnetic dangers exist in transporting and scanning these children. Airway and invasive catheter loss and limitations of continuous measurement of ICP in the MRI suite are of concern. This article should be of interest to any pediatric anesthesiologist who cares for these children and the multiple surgical procedures which they must sometimes endure.

Reviewed by Joseph Tobin, MD #include ./footer_include.iphtml