Cranial CT Research Articles

Evaluation of older patients with minor blunt head trauma to identify those who do not have clinically important traumatic brain injury and can be safely managed without cranial computed tomography.

Our primary aim was to identify a low-risk subgroup of older adults (aged 65 and older) presenting to ED with minor head trauma which can be safely managed without a cranial CT (cCT). This was a single-site, prospective, observational, cohort study conducted at a major-referral ED. Alert, haemodynamically stable, older adults with suspected head trauma were eligible. This included both community dwellers and residential aged care facility (RACF) residents. Primary outcome was the proportion of patients who had a clinically important traumatic brain injury (ciTBI) within 42 days of index ED presentation. Secondary outcomes included proportion investigated with a cCT, and proportion needing neurosurgical intervention. Two hundred seventy-six patients (mean age 80.5 years; 53.6% female) were enrolled. The most common mechanism of injury was ground-level fall (93.8%). One in four patients was from RACFs, 30.1% had dementia and 52.2% were on blood thinners. 80.8% had a cCT during the index ED visit. Seven (2.5%) patients had ciTBI within 42 days of index ED presentation. Patients with ciTBI had either external signs of head injury or abnormal neurological exam. All patients with ciTBI were treated conservatively after shared decision-making. Alert, haemodynamically stable, older ED adults with suspected head trauma had a low incidence of ciTBI in the present study. Abnormal physical examination findings were consistently present in patients with ciTBI. Shared decision-making prior to cCT may be the pragmatic way ahead in the management of this patient cohort, especially among those from RACFs.

Deep learning versus human assessors: forensic sex estimation from three-dimensional computed tomography scans

Cranial sex estimation often relies on visual assessments made by a forensic anthropologist following published standards. However, these methods are prone to human bias and may be less accurate when applied to populations other than those for which they were originally developed with. This study explores an automatic deep learning (DL) framework to enhance sex estimation accuracy and reduce bias. Utilising 200 cranial CT scans of Indonesian individuals, various DL network configurations were evaluated against a human observer. The most accurate DL network, which learned to estimate sex and cranial traits as an auxiliary task, achieved a classification accuracy of 97%, outperforming the human observer at 82%. Grad-CAM visualisations indicated that the DL model appears to focus on certain cranial traits, while also considering overall size and shape. This study demonstrates the potential of using DL to assist forensic anthropologists in providing more accurate and less biased estimations of skeletal sex.

Acute Traumatic Epidural Hematoma in Geriatri, case report

Acute epidural haematomas (AEDH) are rare cases in geriatric age group as the dura adheres firmly to the inner table of the cranial bone. Trauma Brain Injuries are attributed to several mechanisms of injury, including falls, motor vehicle or other types of road injuries, sports-related injuries, and interpersonal physical violence or violence by other means (e.g., blast injury). Presentation may range widely from normal mental status to severe intracerebral injury in the elderly although acute deterioration may occur in previously conscious patients. There are only a few studies in the literature concerning acute epidural haematomas in geriatric age group. In our case, a 66-year-old male patient with cranial Computerized Tomography (CT) showed AEDH at the right parietotemporooccipital region.

Cranial Base Changes After Trans-sutural Distraction Osteogenesis in Growing Patients With Cleft Lip/Palate and Midface Hypoplasia

Background: Transesutural distraction osteogenesis (TSDO) is a method of correcting midfacial hypoplasia (MH) secondary to cleft lip and palate (CLP) without osteotomy. However, there has been little research on how the morphology of the cranial base changes postoperatively or whether any correction of the cranial base occurs. Materials and Methods: This retrospective study included 35 pediatric patients with MH secondary to CLP, who underwent TSDO treatment. Pre-treatment and post-treatment cranial computed tomography (CT) images were collected for cranial base measurements using 3-dimensional (3D) modeling reconstruction. For the comparative analysis, 102 children with normal craniofacial CT images were selected after matching for age and sex. Results: Comparison with normal children of the same age showed that the lengths and angles of several cranial base segments approached normal levels after treatment. In total, the authors found extreme extension in the anterior segment of the sphenoid bone, and in the middle cranial fossa. Simultaneously, TSDO therapy led to the anteroposterior diameter of the lateral pterygoid processes and vomer bone greatly exceeding the normal range, thus causing forward development of the midface skeleton. Conclusion: After the TSDO procedure, the cranial base length and angles approached normal dimensions, accompanied by the forward advancement of the midfacial skeleton. Among the cranial base structures, TSDO resulted in the most noticeable increase in the sphenoid bone in terms of linear measurements and angles, thus promoting midfacial development in children.

Otogenic brain abscess and concomitant acute COVID 19 infection - case report and review of the literature.

COVID-19 has attracted global attention primarily because of the severe acute respiratory symptoms associated with it. However, nearly one third of the patients also present with neurologic symptoms. This report describes a case of a previously healthy woman with acute COVID-19 infection, who developed acute facial nerve palsy and rapid progression to coma due to otogenic brain abscess. A 63-year-old woman with acute COVID-19 infection exhibited acute facial nerve paresis, high fever and purulent secretion from her left ear within 48 hours after COVID-19 onset. Cranial CT scan confirmed acute mastoiditis, precipitating an urgent mastoidectomy. A postoperative contrast-enhanced MRI on the same day revealed a subdural empyema, which prompted an urgent craniotomy and decompression. Intraoperative microbiological swabs confirmed a Streptococcus pyogenes infection, however RT-PCR was negative for SARS-CoV-2. After immediate i.v. antibiotic treatment, extubation was achieved four days post-operation, and the patient was discharged without neurologic deficits 19 days after postoperatively. This finding adds a layer of insight into the specific nature of the infection, suggesting a potential absence of SARS-CoV-2 involvement in otogenic subdural empyema. However, the impact of SARS-CoV-2 in otogenic brain abscess cannot be excluded to date and should be further prospectively investigated. The complete recovery of neurological status, emphasizes the importance of prompt and interdisciplinary interventions in managing rare and severe complications associated with COVID-19.

Management of acute community-acquired bacterial meningitis : Leading symptoms of impaired consciousness and fever with/without headache

Simultaneous symptoms of impaired consciousness and fever are suspicious for acute bacterial meningitis. This is amedical emergency and prompt action is essential. The clinical workup for suspected bacterial meningitis as well as treatment recommendations and differential diagnosis for the main symptoms of decreased vigilance and fever are described. Evaluation of selective literature using PubMed (U.S. National Library of Medicine®, Bethesda, MD, USA), especially taking into account the AWMF (Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften) guideline of community-acquired bacterial meningoencephalitis in adults. Bacterial meningoencephalitis presents with the main symptoms of impaired consciousness, nuchal rigidity, headache and fever, which may, however, be absent in some cases. The diagnosis is confirmed by investigation of the cerebrospinal fluid. Further diagnostics include emergency laboratory tests, blood cultures, microbiological examinations, and cranial computed tomography (CCT). Empirical treatment should be administered promptly. Acute bacterial meningitis must be considered in cases of loss of vigilance and fever, requiring arapid, structured approach in the emergency department.

Clinical and genetic characteristics of hypoparathyroidism in children: a multicenter experience in China.

This study was aimed to analyze the clinical and genetic characteristics of hypoparathyroidism in children. We performed a retrospective analysis of 74 patients diagnosed with pediatric hypoparathyroidism from 2014 to 2023, recruited in five medical centers across China. Data of basic information and clinical tests were extracted from patients' records. Whole-exome sequencing (WES), multiplex ligation-dependent probe amplification (MLPA), and chromosomal microarray analysis (CMA) were utilized to identify the genetic causes. The results indicated a median onset age of 6.07 ± 4.82 years and a median diagnosis age of 6.91 ± 4.88 years. Of the 46 patients who underwent genetic tests, 35 were found to carry pathogenic variants related to hypoparathyroidism. Specifically, 19 cases (19/46, 41.30%) had 22q11.2 microdeletion, while other variations included AIRE (8/46, 17.39%), GATA3 (3/46, 6.52%), CaSR (2/46, 4.34%), and the rest 3 patients with mutations of TBCE, PTH and mitochondrial gene deletion respectively. Convulsions were the most common initial presentation, observed in 43 cases. The non-DGS group exhibited the lowest serum PTH levels compared to DiGeorge syndrome and gene-negative group. Among the 66 patients who underwent cranial CT or MR, 26 (26/66, 39.99%) presented with intracranial calcification. We reported the largest cohort of childhood hypoparathyroidism with genetic diagnoses, reinforcing the view that genetic disorders account for the majority of pediatric hypoparathyroidism, with the 22q11.2 microdeletion being the most prevalent. Identifying the genetic causes of hypoparathyroidism is crucial for predicting patient outcomes, managing comorbidities, and, importantly, informing decisions regarding the potential use of emerging recombinant human PTH therapy.

Systematic vitamin K antagonist reversal with prothrombin complex concentrate in patients with mild traumatic brain injury: randomized controlled trial.

Traumatic brain injury (TBI) in patients on vitamin K antagonists (VKAs) is linked to a high rate of intracranial hemorrhage (ICH). Rapid reversal can reduce ICH progression and mortality, but its effectiveness depends on the time between bleeding onset and coagulation normalization. The PREVACT study aimed to assess the efficacy and safety of prompt systematic reversal of anticoagulation in patients presenting to emergency departments (EDs) for recent mild-TBI while receiving a VKA. A randomized, open-label, blinded-endpoint clinical trial was conducted in 21 French EDs. Patients receiving a VKA, having experienced a TBI within the last 6 h, and presenting a Glasgow Coma Score ≥13 were included. Patients were randomized to systematic immediate VKA reversal with 25 IU/kg of four-factor prothrombin complex concentrate (4f-PCC) before any investigation (intervention group) or standard-of-care signifying reversal only if the initial cranial computed tomography (CT) scan indicated ICH (control group). The primary outcome was the rate of ICH detected on a cranial CT scan 24 h post-inclusion. The study was prematurely stopped for logistic reasons after the randomization of 202 patients (101 and 101 in the intervention and control groups, respectively, mean age 90; 51.8% female). On the 24-h cranial CT scan, 6 of 98 patients (6.1%) in the intervention group manifested ICH vs. 12 of 99 patients (12.1%) in the control group [odds ratio: 0.47 (95% confidence interval: 0.14-1.44); P = 0.215]. In patients with recent mild-TBI receiving a VKA, systematic prompt reversal with 4f-PCC did not statistically significantly reduce ICH rate at 24 h. However, the study was prematurely stopped and does not exclude a clinically relevant benefit of the strategy tested. Clinicaltrials.gov (NCT01961804).

MELAS Presenting as Bilateral Symmetric Occipital and Temporal Cortices Lesions: A Case Report and Literature Review.

Mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke-like episode (MELAS) is one of the most common maternally inherited mitochondrial diseases. The stroke-like episode affecting the cortical cortex is the hallmark of MELAS; however, it rarely presents as simultaneously bilateral symmetric cortices lesions. We reported a case of MELAS in a 46-year-old female patient with bilateral symmetric occipital and internal temporal cortices involvements on brain magnetic resonance imaging (MRI). A literature review of MELAS patients and a retrospective analysis were performed. She had a family history of diabetes. Although she denied a history of diabetes, elevated blood glucose was noted after admission, and diabetes was diagnosed. Laboratory examination revealed elevated lactate acid and creatine kinase levels in blood. Cranial computed tomography (CT) image demonstrated basal ganglia calcification, as well as subtle decreased attenuation in bilateral symmetric occipital and internal temporal cortices. Brain magnetic resonance imaging (MRI) demonstrated symmetric gyriform hyperintensity in bilateral occipital lobes and internal temporal lobes in both grey and white matter on fluid-attenuated inversion recovery (FLAIR) images with restricted diffusion on diffusion weighted images (DWI). A genetic test revealed a point mutation in the mtDNA(3243A > G) by blood examination. Literature review showed that there were 231 eligible patients with MELAS identified from 212 published papers. Symmetric cortical involvements were seen in 15 (6.5%) patients on brain MRI. MELAS should be considered as a potential diagnosis in the patients with bilateral symmetric stroke-like cortices lesions.

Mobile computed tomography at the Munich Oktoberfest : From idea to implementation.

The Munich Oktoberfest, the largest folk festival in the world, attracts around 6.2million visitors over 16-18days. Some of the visitors exhibit certain risky behaviors, leading to asignificantly increased number of medical emergencies during the festival. During Oktoberfest, the prehospital and clinical emergency services of the city are heavily strained, as one-third more ambulances are needed, and over 7000 patients must be treated on-site each year. Until 2022, there was no option for guideline-compliant radiological assessment on-site for patients with head or facial trauma and suspected serious trauma-related injuries. This required alarge number of emergency service admissions to hospitals, mostly for outpatient assessments. To relieve the overburdened medical system, amobile computed tomography (CT) scanner was set up on the Oktoberfest grounds in 2022 for the first time. Amobile CT scanner at the Munich Oktoberfest was utilized for diagnosing injuries to the face, cranium, and cervical spine. For an indication of cranial CT, we used acombination of the Canadian CT Head Rule and NEXUS criteria. Despite the complex structural conditions, this integration seamlessly fit into the structured processes of the on-site medical service. Since this deployment was, to our knowledge, the first of its kind globally, we had to develop and implement new clinical concepts and procedures tailored to the unique conditions of afolk festival. We demonstrated that aCT scanner could be effectively integrated into the preclinical processes of amedical service without direct hospital connection. On-site CT diagnostics proved to be ahighly effective means of avoiding unnecessary transportation to the hospital. Consequently, areduction in emergency medical service provision and stabilization of clinical emergency medicine during the Oktoberfest became feasible. From the authors' perspective, establishing amobile CT scanner at events with high or very high demands on preclinical and clinical emergency medicine is feasible and provides significant relief for the system. The primary goal of stabilizing prehospital and clinical emergency structures, as well as improving the detection and treatment of potentially life-threatening patients on-site, was successfully achieved. Careful integration into the overall process flow is essential.

National trends in catheter angiography and cerebrovascular imaging in a group of privately insured patients in the US

BackgroundDespite the increasing use of non-invasive imaging, DSA remains the gold standard for cerebrovascular imaging. However, trends in DSA utilization are poorly understood. The goal of this study was to...

Prognostic role of serum copeptin levels in adults with graded traumatic brain injury.

The efficacy of copeptin in patients with severe head injuries remains unclear. To investigate the role of serum copeptin levels in detecting intracranial injury, assessing trauma severity, and predicting outcomes in adults with graded traumatic brain injury (TBI). This prospective non-randomized controlled study enrolled 78 adults with isolated head trauma, as well as 59 age- and sex-matched controls. Baseline serum copeptin levels were measured in both groups. Patients were categorized by head trauma severity using Glasgow Coma Scale (GCS) scores (severe GCS 3-8, moderate GCS 9-13, mild GCS 14-15) and by the presence of intracerebral or extracerebral lesions on cranial computed tomography (CCT). Patients were also classified as survivors or non-survivors. Serum copeptin levels were compared among these. Mean serum copeptin levels were significantly higher in patients with graded TBI than in controls. Furthermore, patients with severe and moderate head trauma had significantly higher copeptin levels compared with patients exhibiting mild trauma. An optimal copeptin cutoff value of > 1147pg/mL was identified, indicating the presence of moderate or severe trauma in TBI patients. Patients with abnormal CCT findings had significantly higher mean serum copeptin levels compared with patients exhibiting normal CCT scans. Non-survivors also showed significantly higher serum copeptin levels compared with survivors. Serum copeptin levels rise after graded TBI and can distinguish between patients with and without intracranial or extracranial lesions evident on CCT. Copeptin levels also aid in identifying moderate or severe TBI and in predicting 28-day mortality.

Application of 3D-Slicer Software in the Treatment of Gliomas.

To explore the application of 3D-Slicer multimodal image fusion technology in the surgical treatment of gliomas. A retrospective analysis of clinical data from 48 cases of intracranial gliomas treated with 3D-Slicer multimodal image fusion technology from September 2021 to February 2023. Preoperative cranial CT, MRI, TOF-MRA, DTI, and MRV sequence examinations were completed. DICOM format medical imaging data were processed using the 3D-Slicer software. Multimodal fusion and 3-dimensional reconstruction of the tumor and surrounding structures were conducted to clarify the relationship between the tumor and surrounding structures. The surgery path was simulated through 3D virtual visualization images, enabling precise preoperative planning and assisting in surgical treatment. Out of 48 patients, complete tumor resection was achieved in 45 cases. One case encountered severe postoperative cerebral edema, no infections were reported, 1 patient had slightly reduced muscle strength after surgery compared with before, and no cases of severe neurological function damage or surgical death were recorded. 3D-Slicer multimodal image fusion technology can assist in detailed preoperative planning for the surgical treatment of intracranial glioma, reducing surgical complications, improving the rate of total tumor resection, and reducing postoperative complications.

Concordance and Discordance Between Radiology Residents and Consultant Radiologist Interpretation Of CT Brain

OBJECTIVES The primary objective of this study is to assess the degree of concordance and discordance between the interpretations of computed tomography (CT) brain images by resident and consultant radiologists while emphasizing the critical significance of accurate image interpretation for informed clinical decision-making. METHODOLOGY The evaluation of radiology reports for CT Brain interpretation through a prospective analysis at the Radiology Department of Rehman Medical Institute over two years, from 1st October 2020 to 31st October 2022. A total of 198 patients who underwent cranial CT scans were interpreted by residents (R1, R2, R3, R4). Following this, the consultant radiologists reviewed the images and completed their reports. The reports of the residents and the consultant radiologists were then compared, and concordance was achieved when the residents’ reports were consistent with the final radiologist’s reports. The data collected were recorded in Microsoft Excel. The statistical analysis was performed using SPSS version 22 (IBM Corp., Armonk, NY), and the kappa coefficient was used to determine the level of agreement between residents and consultants.RESULTSAmong the 198 CT Head reports evaluated, 186 of them were in agreement with the final report of the consultant radiologist. Of the correctly diagnosed cases, R1 correctly diagnosed 46 cases, R2 correctly diagnosed 80 cases, R3 correctly diagnosed 54 cases, and R4 correctly diagnosed 6 cases. Our study achieved a percentage agreement of 93.93, with a Cohen's kappa coefficient of 0.8.CONCLUSIONThe overall concordance rate between residents and consultant radiologists was 93.93%, with a kappa coefficient 0.8. This high kappa coefficient indicates strong agreement between the two groups.

An Artificial Intelligence Algorithm Integrated into the Clinical Workflow Can Ensure High Quality Acute Intracranial Hemorrhage CT Diagnostic.

Intracranial hemorrhage (ICH) is alife-threatening condition requiring rapid diagnostic and therapeutic action. This study evaluates whether Artificial intelligence (AI) can provide high-quality ICH diagnostics and turnaround times suitable for routine radiological practice. Aconvolutional neural network (CNN) was trained and validated to detect ICHs on DICOM images of cranial CT (CCT) scans, utilizing about 674,000 individually labeled slices. The CNN was then incorporated into acommercial AI engine and seamlessly integrated into three pilot centers in Germany. Areal-world test-dataset was extracted and manually annotated by two experienced experts. The performance of the AI algorithm against the two raters was assessed and compared to the inter-rater agreement. The overall time ranging from data acquisition to the delivery of the AI results was analyzed. Out of 6284 CCT examinations acquired in three different centers, 947 (15%) had ICH. Breakdowns of hemorrhage types included 8% intraparenchymal, 3% intraventricular, 6% subarachnoidal, 7% subdural, < 1% epidural hematomas. Comparing the AI's performance on asubset of 255 patients with two expert raters, it achieved asensitivity of 0.90, aspecificity of 0.96, an accuracy of 0.96. The corresponding inter-rater agreement was 0.84, 0.98, and 0.96. The overall median processing times for the three centers were 9, 11, and 12 min, respectively. We showed that an AI algorithm for the automatic detection of ICHs can be seamlessly integrated into clinical workflows with minimal turnaround time. The accuracy was on par with radiology experts, making the system suitable for routine clinical use.

Age estimation from median palatine suture using computed tomography reconstructed 3D images: a comparison of Northern and Southwestern Chinese populations.

To investigate the potential of computed tomography (CT) images of median palatine suture (MP) for adult age estimation in the Northern and Southwestern Chinese populations. A total of 1110 cranial CT scans from individuals aged 10-79years, including 557 northern Chinese and 553 southwestern Chinese, were collected for analysis. After volume reformation and multiplanar reconstruction, a total of 20 slices of median palatine suture were selected from each individual. The closure of sutures was analyzed into four stages, and the cumulative scores of 20 slices were recorded as the suture closure score (SCS). The correlations between SCS and age were compared among the two Chinese populations residing in diverse geographic regions. Regression models were established for age estimation. The estimation accuracy was evaluated based on the test set. The mean absolute error (MAE) and the correlation between predicted age and chronological age were calculated to evaluate estimation accuracy. The SCS of MP exhibited a significant correlation with age (0.613, northern male; 0.678, southwestern male; 0.730, northern female; 0.704, Southwestern female; 0.662, total). Furthermore, there were statistically significant differences in SCS among different regions and sex groups (p < 0.001). The cubic regression model had the highest R2 value in all subjects, especially among Northern females and Southwestern males, while the power and quadratic regression models showed the highest R2 value in Northern males and Southwestern females, respectively. In the test set, the Northern cohort demonstrated a lower MAE (9.06 ± 7.32years, males; 9.17 ± 5.28years, females) compared to the Southwestern cohort (9.19 ± 7.49years, male; 10.61 ± 6.83years, female). Additionally, it was observed that males exhibited a lower MAE than females in both regional groups. This study demonstrated the potential utility of CT images of the MP for age estimation in Chinese populations, emphasizing the significance of incorporating regional and sex factors within this context.

Comprehensive treatment approach for hemifacial microsomia: Integrating orthognathic surgery with sequential customized implantation

ObjectiveThis study aims to evaluate the clinical outcomes of combining orthognathic surgery with staged patient-specific implants (PSIs) for comprehensive craniofacial asymmetry reconstruction in adult hemifacial microsomia (HFM) patients. MethodsSix adult HFM patients (1 Type I and 5 Type IIa) underwent orthognathic surgery to correct skeletal malocclusion and chin deviation. Sequential PSIs were implanted to address craniofacial asymmetry. Digital lateral cephalograms and cranial CT scans were obtained at four time points: pre-orthognathic surgery (T0), within three months after orthognathic surgery (T1), one year after orthognathic surgery and just before personalized implantation (T2), and after personalized implantation (T3). Evaluation parameters included skeletal and dentoalveolar measures, occlusal cant, chin deviation, skeletal stability, and facial contour symmetry. ResultsAt T1, no significant differences were observed in skeletal movements compared to planned surgical movements (p > 0.05). Similarly, at T2, skeletal movements did not significantly differ from those observed at T1 (p > 0.05), indicating surgical precision and stability. Analysis of skeletal and dentoalveolar parameters, occlusal cant, and chin deviation revealed significant increases in SNB, FH-NPo, and ST N vert-Pog at T1 compared to T0 (p < 0.05), along with notable improvements in chin deviation and occlusal cant (p < 0.05). Comparison of T2 to T1 showed no significant changes in SNB, FH-NPo, ST N vert-Pog, chin deviation, or occlusal cant (p > 0.05), indicating substantial postoperative stability. Following personalized implantation (T3), further significant improvements were observed in skeletal symmetry. ConclusionCombining orthognathic surgery with staged PSIs effectively reconstructs craniofacial asymmetry in adult HFM patients, achieving significant improvements in skeletal alignment, occlusal cant, and chin deviation, with stable outcomes over time.

Estimation of Radiation Dose to the Eye Lens in Cranial Computed Tomography Examinations in Federal Neuro-Psychiatric Hospital Maiduguri, Borno State, Nigeria

Estimation of Radiation Dose to the Eye Lens in Cranial Computed Tomography Examinations in Federal Neuro-Psychiatric Hospital Maiduguri, Borno State, Nigeria

Assessing the Role of Neurosurgical Consultation in The Treatment of Isolated Linear Pediatric Skull Fractures

Objective: Head injuries represent a significant issue for emergency pediatric care. Most brain injuries are rather minor. The majority of individuals experience positive results even when computed tomography (CT) reveals abnormalities. Our goal was to assess the Glasgow Coma Scale (GCS) and clinical course of pediatric patients with head trauma. Score of 15, in which aberrant findings on cranial CT were observed, in order to ascertain the influence of radiographic characteristics on the necessity of hospitalization and the course of clinical care. Methods: Patients under the age of five to thirteen who had inaccessible mild head injuries, GCS scores of fifteen, aberrant CT results, and who were admitted to the emergency room between July 2021 and August 2023 were retrospectively examined. Results: The study involved ninety patients. There were 55 patients (66%) who were male, and (5–13 years). Hospitalization was necessary for eighty-six (85%) of the patients, with a median stay of one day (one to five days). Repeat CT was performed on sixty-eight (70%) of the patients, and radiographic progression was seen in 15 (25%) of the patients. Two patients (3%), out of the ten patients, required surgery for their subdural or epidural hematomas. No radiological or clinical deterioration was observed in patients with a single skull fracture or subarachnoid hemorrhage. Conclusion, even when CT scans reveal abnormalities, surgery may not always be necessary for individuals with head injuries aged 5 to 13 who take a GCS score of 10. Patients with isolated skull fractures before subarachnoid hemorrhages, in example, may not always need to be hospitalized. To validate the results of this investigation, a validation study is required.

Update on the role of S100B in traumatic brain injury in pediatric population: a meta-analysis.

Cranial computed tomography (CT) scan is the most widely used tool to rule out intracranial lesions after pediatric traumatic brain injury (TBI). However, in pediatric population, the radiation exposure can lead to an increased risk of hematological and brain neoplasm. Defined in 2019 National Institute for Health and Care Excellence (NICE) guidelines as "troponins for the brain", serum biomarkers measurements, particularly S100B, have progressively emerged as a supplementary tool in the management of TBI thanks to their capacity to predict intracranial post-traumatic lesions. This systematic review was conducted following the PRISMA protocol (preferred reporting items for systematic reviews and meta-analyses). No chronological limits of study publications were included. Studies reporting data from children with TBI undergoing serum S100B measurement and computed tomography (CT) scans were included. Of 380 articles screened, 10 studies met the inclusion criteria. Patients admitted with mild-TBI in the Emergency Department (ED) were 1325 (80.25%). The overall pooled sensitivity and specificity were 98% (95% CI, 92-99%) and 45% (95% CI, 29-63%), respectively. The meta-analysis revealed a high negative predictive value (NVP) (99%; 95% CI, 94-100%) and a low positive predictive value (PPV) (41%; 95% CI, 16-79%). Area under the curve (AUC) was 76% (95% CI, 65-85%). The overall pooled negative predictive value (NPV) was 99% (95% CI, 99-100%). The measurement of serum S100B in the diagnostic workflow of mTBI could help informed decision-making in the ED setting, potentially safely reducing the use of CT scan in the pediatric population. The high sensitivity and excellent negative predictive values look promising and seem to be close to the values found in adults. Despite this, it must be pointed out the high heterogeneity (> 90%) found among studies. In order for S100B to be regularly introduced in the pediatric workflow for TBI, it is important to conduct further studies to obtain cut-off levels based on pediatric reference intervals.