Song, Cheng Hee
(2017)
Trauma brain injury in paediatric mild blunt head trauma in Hospital Universiti Universiti Sains Malaysia.
Masters thesis, Universiti Sains Malaysia.
Abstract
Background: Paediatric minor head injury is a common presentation in emergency
department worldwide. There is controversy about which patients should undergo
computed tomography (CT) of the brain. The purpose of our study was to identify the
predictors for paediatric traumatic brain injury on CT scan in our population. We also
aimed to determine the association between isolated versus non-isolated vomiting with
traumatic brain injury on CT brain.
Methods: Children with minor head injury (GCS 13-15) presented to Hospital Universiti
Sains Malaysia (USM) during the period from 2009 to 2013 were retrospectively
reviewed. We evaluated clinical variables such as the mechanism of injury, presenting
symptoms and physical signs on the examination for positive traumatic brain injury as
determined by CT brain. The data was analysed by chi-square test, simple and multiple
logistic regression analyses.Results: A total of 274 patients were enrolled into our study. The mean and standard
deviation age of study group was 11.2 (5.39) years old. Traumatic brain injury on CT
scan occurred in 49.3% of patients. On multivariable analysis, we identified the
following three predictors which were statistically significant: headache (adjusted OR
2.24, 95% CI 1.24, 4.05, p=0.008), giddiness (adjusted OR 3.08, 95% CI 1.27, 7.51,
p=0.013) and presence of scalp hematoma (adjusted OR 2.93, 95% CI 1.60, 5.34,
p<0.001). TBI on CT scan occurred in 2 of 24 patients in the isolated vomiting group
versus 71 of 123 in the non-isolated vomiting group. We found significant association
between isolated versus non-isolated vomiting with traumatic brain injury on CT brain
(p<0.001).
Conclusions: Headache, giddiness and presence of scalp hematoma are independent
predictors for minor blunt head injury in our pediatric population. CT brain should be
seriously considered in children presenting with vomiting accompanied by othersymptoms and signs suggestive of traumatic brain injury.
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