- Value of Repeat Brain Computed Tomography in Children with Traumatic Brain Injury
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Ho Jun Jo, Yong Su Lim, Jin Joo Kim, Jin Seong Cho, Sung Youl Hyun, Hyuk Jun Yang, Gun Lee
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J Trauma Inj. 2015;28(3):149-157. Published online September 30, 2015
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DOI: https://doi.org/10.20408/jti.2015.28.3.149
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 Abstract
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- PURPOSE
Traumatic brain injury (TBI) is the most common cause of pediatric trauma patients came to the emergency department. Without guidelines, many of these children underwent repeat brain computed tomography (CT). The purpose of this study was to evaluate the value of repeat brain CT in children with TBI.
METHODS
We conducted a retrospective study of TBI in children younger than 19 years of age who visited the emergency department (ED) from January 2011 to December 2012. According to the Glasgow Coma Scale (GCS) and Pediatric Glasgow Coma Scale score of the patients, study population divided in three groups. Clinical data collected included age, mechanism of injury, type of TBI, and outcome.
RESULTS
A Total 83 children with TBI received repeat brain CT. There were no need for neurosurgical intervention in mild TBI (GCS score 13-15) group who underwent routine repeat CT. 4 patients of mild TBI group, received repeat brain CT due to neurological deterioration, and one patient underwent neurosurgical intervention. Routine repeat CT identified 12 patients with radiographic progression. One patient underwent neurosurgical intervention based on the second brain CT finding, who belonged to the moderate TBI (GCS score 9-12) group.
CONCLUSION
Our study showed that children with mild TBI can be observed without repeat brain CT when there is no evidence of neurologic deterioration. Further study is needed for establish indication for repetition of CT scan in order to avoid unnecessary radiation exposure of children.
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Summary
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Citations
Citations to this article as recorded by  - Mortality and Epidemiology in 256 Cases of Pediatric Traumatic Brain Injury : Korean Neuro-Trauma Data Bank System (KNTDBS) 2010–2014
Hee-Won Jeong, Seung-Won Choi, Jin-Young Youm, Jeong-Wook Lim, Hyon-Jo Kwon, Shi-Hun Song
Journal of Korean Neurosurgical Society.2017; 60(6): 710. CrossRef
- The Use of Brain Computer Tomography Examination with Mild Traumatic Brain Injury in Pediatrics
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Ha Kyung Kim, Jin Joo Kim, Jin Seong Cho, Jae Ho Jang, Hyuk Jun Yang, Gun Lee
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J Trauma Inj. 2014;27(3):63-70.
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Abstract
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- PURPOSE
In children, mild traumatic brain injuries (TBI) account for 70~90% of head injuries. Without guidelines, many of these children may be exposed to excess radiation due to unnecessary imaging. The purpose of this study was to evaluate the impact of a mild TBI guideline in imaging of pediatric patients.
METHODS
The medical records of all children who had head computed tomography and were admitted to our hospital with a TBI with Pediatric Glasgow Coma Scale and Glasgow Coma Scale of 14 to 15 were retrospectively reviewed and compared with PECARN Rule.
RESULTS
A total of 1260 children were included and all children checked with head computed tomography. 61 pediatrics had CT positive and presented skull fracture 40, hemorrhage 8, hemorrhagic contusion 7, and diffuse axonal injury 1. Also, 4 patients diagnosed both skull fracture and brain haemorrhage and 1 patient diagnosed both haemorrhage and haemorrhagic contusion.
CONCLUSION
There are many pediatric traumatic patients who exposed to radiation due to CT. But, the most of results were negative. So, consider to follow the CT guideline for children and many do not require brain CT.
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Summary
- Predictive Indicators for the Severity of Pediatric Trauma and the Prevention of Injuries According to the General Characteristics and Pre-hospital Factors of Severe Pediatric Trauma Patients
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Jae Hyug Woo, Hyuk Jun Yang, Yong Su Lim, Jin Seong Cho, Jin Joo Kim, Won Bin Park, Jae Ho Jang, Gun Lee
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J Trauma Inj. 2014;27(3):43-49.
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Abstract
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- PURPOSE
Trauma is one of the most common causes of death for children, and identifying severely injured children quickly in an overcrowded emergency room (ER) is difficult. Therefore, severe injury must be prevented, and the severity of injuries in children must be determined easily from their general characteristics and pre-hospital factors.
METHODS
Injured children younger than 15 years of age who visited the ER from June 2011 to May 2013 were enrolled. According to the revised trauma score (RTS) of the patients, the study population was divided in two groups, a severe group (RTS<7) and a mild group (RTS> or =7). The general characteristics and the pre-hospital factors were compared between the two groups.
RESULTS
Six hundred seventy-three children were enrolled, their mean age was 8.03 (+/-4.45) years, and 476 (70.73%) patients were male. Of these patients, 22 patients (3.27%) were in the severe group, and 651 patients (96.73%) were in the mild group. Fewer males were in the severe group than in the mild group (50.00% vs. 71.43%, p=0.030), and children in the severe group were younger than children in the mild group (3.50 vs. 8.00 years, p=0.049). In the severe group, toddlers (54.55%, p=0.036) were the most common age group. Severe injuries occurred more often in spring (32.81%) and summer (54.56%) than in autumn (9.09%) and winter (4.55%) (p=0.026). The most common places of injury in the severe group were roads (50.00%, p=0.009), and the most common mechanisms of injury in the severe group were traffic accidents (50.00%), followed by falls (31.82%) (p=0.011). Most severely injured children were transferred by ambulance (72.73%, p=0.000).
CONCLUSION
The results of this study may be helpful for identifying severely injured children quickly in the field and the ER. To prevent severe pediatric injuries, precautions and policies based on these results should be established.
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Summary
- Clinical Profiles of Patients who Undergone Emergency Angiographic Embolization at Emergency Department
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Jong Hyo Sun, Jae Kwang Kim, Yong Su Lim, Jin Joo Kim, Jin Sung Jo, Sung Youl Hyun, Ho Sung Jeong, Hyuk Jun Yang, Gun Lee, Jeong Ho Kim
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J Korean Soc Traumatol. 2009;22(2):248-253.
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Abstract
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- PURPOSE
Hemodynamically unstable pelvic fractures represent therapeutic challenges for the trauma team. The authors of this article have studied the clinical profiles of the angiographic intervention population at the emergency department during four years (2005~2009) to develop clinical guidelines for preventing deaths due to multiple trauma and for predicting the prognosis during initial evaluation.
METHODS
We performed a retrospective review of 34 patients who had undergone angiographic interventions at the emergency department and compared the differences in clinical variables between survivors and non-survivors.
RESULTS
Representative values were compared between survivors and non-survivors : RTS (revised trauma score) 7.006 (6.376~7.841) vs. 6.128 (4.298~6.494), PRC (packed red cell) units 5.5 (2.0~11.0) vs. 15 (8.0~18.5), and lactate (mmol/L) 3.0 (1.0~7.0) vs. 8.5 (3.5~10.5). RTS (p<0.01) and PRC units before angiographic interventions (p=0.01) and lactate (p=0.02) had correlations to the final outcomes.
CONCLUSION
The availability of an angiographic suite and persistent hypotension after adequate fluid resuscitation for pelvic trauma are good indications of angiographic intervention for pelvic hemorrhage.
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Summary
- Analysis of Delayed Diagnosis of Pediatric and Adolescent Patients Injured by Minor Trauma
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Jee Ahn Choi, Won Bin Park, Jin Joo Kim, Jin Sung Jo, Jae Kwang Kim, Yong Su Lim, Sung Youl Hyun, Ho Seong Jeong, Hyuk Jun Yang, Gun Lee
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J Korean Soc Traumatol. 2009;22(2):212-217.
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Abstract
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To analyze delayed diagnosis, we collected date on pediatric and adolescent patients who had been admitted to the Emergency Department with injuries due to minor trauma METHODS: We retrospectively analyzed the age distribution, trauma mechanism, time interval for each affected body region at delayed diagnosis, hospital stay, and outcome for 161 pediatric and adolescent patients who had been admitted to the Emergent Department of Gachon University Gil Hospital from January 2006 to September 2008.
RESULTS
The incidence of delayed diagnosis in pediatric and adolescent trauma was 11.8% in our retrospective review of 161 pediatric and adolescent patients. Lengths of hospitalization were longer in patients with delayed diagnosis (p<0.05). Patients with delayed diagnosis were more often transferred to other hospitals than patients with non-delayed diagnosis (p<0.05). The time intervals for each different affected body regions at delayed diagnosis were significantly different, but the hospital stays were not. There were no statistical significance to age on affected body region.
CONCLUSION
From this study, we found that admission result and hospital stay were statistically significant differences between the delayed-diagnosis patient group and the non-delayed-diagnosis patient group. Finally, we must follow up pediatric and adolescent patients with minor trauma, closely considering missed injuries.
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