• Ешқандай Нәтиже Табылған Жоқ

БАС ЖАРАҚАТЫ КЕЗІНДЕГІ ТОМОГРАФИЯНЫ КАНАДАЛЫҚ БАҒАЛАУ ЕРЕЖЕЛЕРІНЕ СӘЙКЕС БАҒАЛАУ

Сулейман Алтун 1*,

Фиген Джошкун 2

1 SB Diskapi Yildirim Beyazit оқыту-зерттеу ауруханасы, Анкара қ., Түркия;

2 Докуз Эйлул унивеситеті, Медициналық факультет, Шұғыл көмек бөлімі, Измир қ., Түркия.

Мақсат: Жеңіл бас жарақаты бар балаларда (CATCH) бас жарақатына арналған томографияны канадалық бағалау ережелерінің сенімділігін тексеру.

Әдістер: Жеңіл бас жарақатымен түскен бала жасындағы науқастарды проспективті зерттеу. Науқастарды САТСН ережелеріне сәйкес бағалап, оларды 2 топқа бөлді. Сипаттамалы мағына қолданылды - санатты деректерге ол сан және пайыз, жастың орта стандартты ауытқуы, терминдермен көрсетілген. Топтарды салыстыру кезінде категориялық деректерге, Фишердің нақты критериі және хи-квадрат критериіне, Т - критерий үздіксіз деректер үшін тәуелсіз таңдауларда қолданылған, р < 0.05 мәні статистикалық мағынаға ие саналған.

Нәтиже: Жарақаттың ең жиі себебі ойын және спорт жағдайлары болған. САТСН ережелері бойынша біздің есептелінген зерттеуімізде сезімталдық 100%, ерекшелік 48,5%, теріс нәтиженің болжамды құндылығы 51,5%

құрады.

Қорытынды: САТСН ережесі керегі жоқ СТ – зерттеулерінің санын өте тиімді қысқартатыны туралы анықталды.

Түйінді сөздер: бас жарақаты, бала жасындағы, САТСН ережесі.

Bibliographic citation:

Altun S., Coşkun F. The evaluation of patient with childhood minör head trauma according to Canadian Assessment of Tomography for Childhood Head İnjury (CATCH) Rule // Nauka i Zdravookhranenie [Science & Healthcare]. 2020, (Vol.22) 6, pp. 49-53. doi 10.34689/SH.2020.22.6.007

Алтун С., Джошкун Ф. Оценка применения компьютерной томографии у пациентов детского возраста с малой травмой головы в соответствии с правилами канадской оценки томографии при травме головы у детей // Наука и Здравоохранение. 2020. 6(Т.22). С. 49-53. doi 10.34689/SH.2020.22.6.007

Алтун С., Джошкун Ф. Аздаған бас жарақаты бар балалардың компьютерлік томографиясын пайдалана отырып балалардағы бас жарақаты кезіндегі томографияны канадалық бағалау ережелеріне сәйкес бағалау // Ғылым және Денсаулық сақтау. 2020. 6 (Т.22). Б. 49-53. doi 10.34689/SH.2020.22.6.007

Introduction

Head trauma is one of the most common and important causes of mobidity and mortality in childhood. [1-3]. Usually most of the minor head injuries are managed in emergency rooms [1,4]. From the 1980s CT, which has a privileged place especially in head trauma, its use will have attracted attention all over the world over time, Studies have been started to minimize unnecessary CT shots in the world [4-9].

Patients with minor head trauma have to take a CT scan and / or make a decision to observe risk scores is used [4,10,11]. Patients in the low risk group, with close follow-up CT may not be taken. Medium and high risk patients, it is recommended CT scan and long time obssevation in the emergency room [4,5,10,12].

In this study, we aimed to test the reliability of Canadian Assessment of Tomography for Childhood Head İnjury (CATCH) Rule iin children with minor head injury.

Materials and Methods:

This study was conducted between July 15, 2010 - July 15, 2011 at Ministry of Health Ankara Training and Research Hospital Emergency Medicine Clinic. It was performed prospectively on patients admitted due to minor head trauma. Study was worked properly to Helsinki Declaration and Good Clinical Practices Directive. A total of 200 patients with minor head trauma between the ages of 1 and 16 years were included to this study. Patients were evaluated with CATCH rule and divided into 2 groups. 100 patients taken tomography as Group 1, and 100 patients not taken tomography as Group 2 was defined.

Controls were made on the 1st, 7th and 14th days of the patients included in the study. Age and gender of the patients mechanism of trauma, symptoms and signs, whether or not CT was taken, if CT was taken outcomes were recorded in standard forms. The emergencies were

verbally explained to the patients who did not taken CT, before discharge from the emergency room.

Statistical analysis

Statistical evaluation of the data was made with SPSS for Windows 15.0 package program. Descriptive values are number and percentage for categorical data, mean ± standard deviation for age expressed in terms. For categorical data in comparison of groups, Chi-Square and Fisher-Exact test, T test was used on independent samples

for continuous data. p <0.05 value was considered statistically significant.

Results

Of the patients included in the study, 131 (65.5%) were male and 69 (34.5%) were female. Those with CT scanner the mean age was 5.74 ± 4.40 years, it was 5.57 ± 3.54 years for those who did not taken CT. The most common cause of travma was game and sports injuries (Table 1).

Table 1.

Characteristics of patients.

Variable Not CT taken CT taken p

Gender Male/female 64/36 67/33 0.655

Age 5,74±4,40 5,57±3,54 0.764

Cause of trauma Play and sports injulies 46(%) 26(%) 0.000

Fall from <91 cm 8(%) 0(%) 0.000

Fall from≥91 cm 0(%) 46(%) 0.000

Crash 46(%) 23(%) 0.001

Fall from bicycle 0(%) 3(%) 0.081

Pedestrian accident 0(%) 2(%) 0.155

Symptom Nausea 0 25(%)

Vomiting 0 30(%)

Progresif headache 0 37(%)

Scalp hematoma 24(%) 25(%) 0.869

Scalp laceration 40(%) 30(%) 0.138

Fracture sign 0 1(%)

Confusion 0 4(%)

The risk distribution of patients who taken CT was calculated according to CATCH rule. 59 (29.5%) patients in the high risk group, 41 (20.5%) patients were in the medium risk group (Table 2).

Table 2.

The risk distribution of patients CT taken according to CATCH rule.

CATCH rule Number %

High risk

GCS <15 at 2 hours after injury 4 4%

Suspected open or depressed skull fracture 6 6%

History of worsening headache 37 37%

İrritability on exam 12 12%

Medium risk

Any signs of basal skull fracture 1 1%

Large boggy scalp hematoma 1 1%

Dangerous mechanism of injury 39 39%

Pathological findings were found in 6 (6%) patients in the CT taken group (Table 3). In the group not taken BT there is no finding was found as a result of follow-up. In our study, the CATCH rule has been calculateted sensitivity 100%, specificity 48.5%, and negative predictive value was 51.5%.

Table 3.

Pathological CT findings.

CT outcome N (%)

Linear fracture 3 (3%)

Depressed skull fracture 1 (1%)

Epidural hematoma 1 (1%)

Cerebral confusion 1 (1%)

Discussion

In our study, sensitivity of the CATCH rule was 100%, specificity 48.5%, negative predictive value was calculated as 51.5%. Osmand et al. had 100% sensitivity 70.2%

specificity reported [5]. Kavalcı et al. were reported the sensitivity and specificity of Canadian CT Head Rule (CCHR) that they were 76.4% and 41.7% respectively [8].

İn our study, the most common pathology in CT outcomes was isolated linear fracture (3%). Katırcı et al reported that Linear fracture was the most common pathology in the study [3]. Our results are consistent with the literature.

In our study, the average age of the cases was calculated as 5.66 years. It has been reported in the literature that head injuries peak under 5 years of age [10].

Our In our study, the average age was found to be higher.

The reason for this is 1 year six children being excluded from the study and the result of increased parental education and awareness It can be shown that trauma measures are more successful.

Head injuries are more common in men than women [5,13,14]. 200 cases participating in our study 131 (65.5%) male and 69 (34.5%) consisted of girls. Boys are more play on the street than girls they may be more exposed to trauma.

Falls and crashes as the most common mechanism of trauma in the literature, motor vehicle accidents were reported subsequently [4,8,15]. Osmond et al. In their study, the most cause of head trauma was falls with a rate of 44.9%, while the second sports injuries were reported with 22.6% [5. 200 patients included in our study, when trauma mechanisms are examined, the most common reasons are

sports and game injuries (36%), and head collisions (34.5%). It is seen as the cause and it is followed by falls from height (27%). Trauma mechanisms observed in our study are different from the order in the literature. The reason for this is both falling from height and straight taking falls on the ground, we evaulated these patients in the CATCH rule as a fall criteria. In our study, motor vehicle accidents were found to be scarcely. This is because we only get minor head injuries and most motor vehicle accidents cause severe head injuries.

The most common symptom in patients with head trauma is headache. When literature examined, Alexander et al. compared patients with minor and severe traumatic brain injury(TBI) and 87% in patients with minor TBI, 38% in patients with severe TBI they found a headache [16]. Nee et al. in a study, they have done they found vomiting at a rate of 28% in adults and 33% in children in TBI [17]. In our study, we detected the most common symptom in patients was nausea-vomiting, with a rate of 25.5% and progressive headache was the second most common (18.5%). Our headache and vomiting symptoms in our study are similar to those in the literature.

CATCH rule include high indications for CT imaging in head injuries and are evaluated in two groups as medium risk and high risk. In our study, a total of 59 (29.5%) patients had high risk criteria. Most frequent from the high risk group worsening headache (18.5%), the second most common irritability on examination (6%) has been observed.

Osmond et al. reported the rate of patients meeting the high risk criteria was reported as 30.2%, they have made most frequently worsened headache with a rate of 16.1%, the second most common irritability took place with a rate of 10.8% [5]. Our study was almost completed with the work of Osmond et al. has the same results. Osmond et al. reported in their 3866 person studies, reported the number of patients who met Canadian rule 81.1%, 50.1% of these patients meet medium risk criteria and dangerous trauma mechanism is the most common 31% in the medium risk group [5].The results of our study and that of Osmond et al.

are parallel. Apart from this study, there has been found no stud conducted in the childhood age group based on Canadian rule. Studies conducted on adults with Canadian criteria have been described, However, the Canadian criteria prepared for adult and childhood age groups are different from each other [4]. This is due to the different rates of trauma mechanisms in the childhood age group, anatomy and the direct and indirect effects of traumas on childhood different effects can be shown.

In our study, pathological findings were detected on CT in 6 (3%) patients. This rate is 6% in the case group undergoing CT. All of these cases are they have been treated with conservative methods. There was no sequelae in any patient. Osmond and et al. detected pathological findings in CT at a rate of 4.1% in their studies, however, they did not include linear fractures in this group. 4.3% in the same study a linear fracture has been reported. Surgical intervention was performed in 0.6% of the patients [5]. In some other studies reported approximately 5% have been abnormal CT findings of minor head trauma patients with GCS 15 who apply to emergency services [18,19]. The rates are similar in our study. In our study, the low number

of patients and not being a primary child trauma center, constituted a limiting factor.

Osmond e al. reported rate of positive disease in patients outside the Canadian criteria is under 1% [5. In our study, 100 (50%) patients who did not have CT no problem was found. This situation reduces the possibility of abnormal CT. Although not excluded, it is an important indicator of mortality and morbidity. So CT Positive disease rate is 0% in patients who are not taken CT. In this case, the Canadian criteria Patients who did not undergo CT were protected from unnecessary radiation exposure. In addition, unnecessary labor and cost are prevented.

Despite the small number of cases in our study, the results are quite satisfactory. Morbidity and mortality were not encountered in any of our patients.

Conclucion

We found the CATCH rule was very successful in reducing unnecessary CT shots. However, proving the suitability of these criteria for our country and, if necessary, a large number of patients to establish new modified criteria around these criteriaand multi-center studies are needed.

Conflict of Interesting: No conflict

Lİmitation of study: The most limitation of study, it is the low number of cases.

Funding: There is no financial support and sponsorship Conflict of Interests: The authors declare that they have no conflict of interest.

Contribution of the authors to the study:

Suleyman Altun - literature search, writing a review, developing ideas and concepts;

Figen Coşkun - developing ideas and concepts, methodologically assessing the quality of the articles included, writing a review;

Financing: During this work, there was no funding from outside organizations and medical missions.

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* Coresponding Author

Suleyman Altun - Dışkapı Yıldırım Beyazıt Traning and Research Hospital, Emergency Department, Ankara/Turkey E-mail: s.altun.dr@gmail.com

Phone:+905059438999

Получена: 21 октября 2020 / Принята: 12 декабря 2020 / Опубликована online: 30 декабря 2020 DOI 10.34689/SH.2020.22.6.008

УДК 616.36-002-073.782

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