Computed tomography of intracranial hemorrhages in injured infants and little children aged from 0 months till 3 years

Abstract

Introduction. The most common reason for young children to seek medical aid in hospitals is head injuries caused by falls from a small height. Currently, computed tomography (CT) of the head is a preferred method for rapid detection of bone fractures and brain injuries in children.Purpose. To investigate specific features of CT signs of intracranial hemorrhages in children with TBI under three years of age.Material and methods. 1334 children aged less than one month to 3 years with isolated TBI were examined at CT scanning. 128-slice scanner "Ingenuity CT" (Philips) was used for the examination. Scanning of the area of interest (head + cervical spine) was performed at the lowest possible values to reduce radiation exposure, including the O-MAR program, with step 0.75 mm at slice thickness 0.75 mm; reconstruction interval was 2 mm. The voltage applied to an X-ray tube during scanning (kV), current strength and time (mAS) were selected depending on patient's weight and age. The effective dose range was from 1.27 mSv to 1.91 mSv.Results. In 510 out of 1334 injured children (38.2%), there were traumatic injuries of various degree, from uncomplicated cephalohematomas and linear fractures to massive intracranial hematomas and total cerebral edema; the rest 61.8% (n=824) had concussion. The performed CT scanning revealed that 87.84% (448/510) children had skull fractures, of which only 18.3% (82/448) had “isolated skull fractures”; the others (366 = 81.7%) had accompanying intracranial injuries.Discussion. Pathological changes in children, aged 0 mon-3 years, after TBI are significantly different of those in children of other age groups. CT is the basic primary diagnostic instrument and should be used in all children with TBI no later than the first three hours. Radiation diagnostics play a key role in putting a correct diagnosis, if physicians use the information obtained at CT and know TBI mechanism in infants and little children.Conclusion. CT is an imaging method of choice for acute TBI in little children to accurately identify and therefore treat intracranial lesions. In addition, CT is an effective diagnostic tool in detecting secondary traumatic injuries.