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Alterações imagiológicas dos traumatismos crânio-encefálicos na idade pediátrica
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Introdução: Os traumatismos crânio-encefálicos (TCE) apresentam elevada prevalência na idade pediátrica, constituindo uma causa importante de morbilidade e mortalidade infantil. A tomografia computorizada crânio-encefálica (TC-CE) apresenta-se como o método diagnóstico de eleição dos TCE no serviço de urgência, pela sua ampla disponibilidade e rapidez na aquisição das imagens. O objetivo do presente estudo consistiu em caracterizar os dados clínicos e imagiológicos agudos de doentes pediátricos que tenham sofrido traumatismo crânio-encefálico e/ou vértebro-medular, bem como relacionar o mecanismo de lesão traumática e as manifestações clínicas à admissão com a existência de alterações neuro-imagiológicas.
Métodos: Foi concretizado um estudo retrospetivo de doentes em idade pediátrica, diagnosticados com traumatismo crânio-encefálico e/ou vértebro-medular, no Serviço de Urgência do Hospital Santa Maria, entre janeiro e outubro de 2022, que realizaram estudo de imagem. Foram recolhidos e analisados os dados clínicos e imagiológicos dos doentes. A análise estatística foi realizada através do SPSS (v24.0) e posteriormente analisada.
Resultados: Amostra constituída por 380 doentes, com predomínio do sexo masculino (58%) e de crianças com idade inferior a 4 anos (40,5%). A idade média foi de 7,7±5,9 anos. A queda foi o mecanismo de lesão mais frequentemente relatado nos grupos etários dos 0-4 anos e 5-9 anos e o acidente de viação o mais reportado nos outros dois grupos etários (10-14 anos e 15-17 anos). As manifestações clínicas mais comuns à admissão no serviço de urgência foram o hematoma epicraniano (30%), os vómitos (22%) e a sonolência (19%). As quedas de superfície e os acidentes de viação foram identificados como mecanismos de lesão traumática preditores de existência de lesão crânio-encefálica e/ou vértebro- medular nos exames de imagem, bem como a apresentação à admissão com hematoma epicraniano ou com alteração do estado de consciência. A TC-CE foi o método de imagem realizado em todos os doentes, sendo observado alterações em 16,6%. As lesões mais comumente identificadas foram a fratura do crânio (63,5%), o hematoma subdural (36,5%), a hemorragia subaracnoideia (20%), a contusão cerebral (19%) e o hematoma epidural (15,8%). Pela suspeita de lesão
vertebral, foram efetuados TC da coluna vertebral em 57 doentes, sendo encontradas alterações em 8 (14,03%) estudos, com destaque para a fratura vertebral e a lesão articular.
Conclusão: Os TCE apesar de muito frequentes na idade pediátrica, apresentam baixa prevalência de lesão crânio-encefálica. A TC-CE identifica e caracteriza precocemente as lesões decorrentes do traumatismo. No entanto, a sua utilização deve ter em conta fatores clínicos preditores de alterações imagiológicas, como o mecanismo de lesão traumática e as manifestações clínicas à admissão no Serviço de Urgência, para evitar a exposição desnecessária à radiação ionizante. O clínico deve ainda permanecer em alerta para lesões decorrentes do traumatismo vértebro-medular, frequentemente em concomitância com o TCE.
Background and purpose: Traumatic brain injury (TBI) is highly prevalent in children and is an important cause of morbidity and mortality. Brain CT is the diagnostic method of choice in the acute setting, being widely available and quickly obtainable. The aim of this study was to characterize the clinical and imaging data of pediatric patients who suffered traumatic brain or spinal injury, as well as to associate the mechanism of traumatic injury and clinical manifestations at admission with the existence of neuroimaging findings. Methods: Retrospective analysis of patients diagnosed with traumatic brain or spinal injury at the Emergency Department of Santa Maria Hospital between January and October 2022, who had an imaging study. Clinical and imaging data of the patients were collected and analyzed. Statistical analysis was performed and analyzed using SPSS. Results: Three hundred and eighty patients were eligible, predominantly male (58%) and children under 4 years old. Mean age was 7.7 ± 5.9 years. Fall was the most frequently reported injury mechanism among the youngest and road traffic accident among the oldest. The most common clinical manifestations were epicranial hematoma (30%), vomiting (22%) and drowsiness (19%). Falls from height and road traffic accidents were identified as mechanisms of traumatic injury that were predictive of the existence of imaging findings, as well as the presentation on admission with epicranial hematoma or altered state of consciousness. Brain CT was performed in all patients, with imaging findings in 16.6%. The most commonly identified injuries were skull fracture (63,5%), subdural hematoma (36,5%), subarachnoid hemorrhage (20%), epidural hematoma (15,8%), and cerebral contusion (19%). Due to suspicion of concomitant spinal injury, CT of the spine was performed in 57 patients and changes were found in 8 (14,03%), with emphasis on vertebral fracture and joint injury. Conclusion: TBI is very frequent in pediatrics and most of them are mild. Brain CT identifies early injuries resulting from trauma. However, to avoid unnecessary exposure to ionizing radiation, its use has to take into consideration clinical factors that predict the existence of imaging findings, such as the mechanism of traumatic injury and clinical manifestations at admission. The clinician should also remain alert for injuries resulting from spinal injury, often concomitant with TBI.
Background and purpose: Traumatic brain injury (TBI) is highly prevalent in children and is an important cause of morbidity and mortality. Brain CT is the diagnostic method of choice in the acute setting, being widely available and quickly obtainable. The aim of this study was to characterize the clinical and imaging data of pediatric patients who suffered traumatic brain or spinal injury, as well as to associate the mechanism of traumatic injury and clinical manifestations at admission with the existence of neuroimaging findings. Methods: Retrospective analysis of patients diagnosed with traumatic brain or spinal injury at the Emergency Department of Santa Maria Hospital between January and October 2022, who had an imaging study. Clinical and imaging data of the patients were collected and analyzed. Statistical analysis was performed and analyzed using SPSS. Results: Three hundred and eighty patients were eligible, predominantly male (58%) and children under 4 years old. Mean age was 7.7 ± 5.9 years. Fall was the most frequently reported injury mechanism among the youngest and road traffic accident among the oldest. The most common clinical manifestations were epicranial hematoma (30%), vomiting (22%) and drowsiness (19%). Falls from height and road traffic accidents were identified as mechanisms of traumatic injury that were predictive of the existence of imaging findings, as well as the presentation on admission with epicranial hematoma or altered state of consciousness. Brain CT was performed in all patients, with imaging findings in 16.6%. The most commonly identified injuries were skull fracture (63,5%), subdural hematoma (36,5%), subarachnoid hemorrhage (20%), epidural hematoma (15,8%), and cerebral contusion (19%). Due to suspicion of concomitant spinal injury, CT of the spine was performed in 57 patients and changes were found in 8 (14,03%), with emphasis on vertebral fracture and joint injury. Conclusion: TBI is very frequent in pediatrics and most of them are mild. Brain CT identifies early injuries resulting from trauma. However, to avoid unnecessary exposure to ionizing radiation, its use has to take into consideration clinical factors that predict the existence of imaging findings, such as the mechanism of traumatic injury and clinical manifestations at admission. The clinician should also remain alert for injuries resulting from spinal injury, often concomitant with TBI.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2023
Palavras-chave
Traumatismo crânio-encefálico Pediátrico Tomografia computorizada Traumatismo vértebro-medular Imagiologia