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Vol. 60. Núm. 6.
Páginas 561-568 (Junio 2004)
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Vol. 60. Núm. 6.
Páginas 561-568 (Junio 2004)
Acceso a texto completo
Utilidad diagnóstica de la radiografía en el traumatismo craneal. Una revisión crítica de la bibliografía
Diagnostic utility of radiography in head trauma: A critical review of the literature
Visitas
20571
P.J. Alcalá Minagorrea,
Autor para correspondencia
palcala@wanadoo.es

Correspondencia: Servicio de Pediatría. Hospital General Universitario de Alicante. Maestro Alonso, 109. 03010 Alicante. España
, J. Aranaz Andrésb, J. Flores Serranoa, L. Asensio Garcíab, A. Herrero Galianaa
a Servicio de Pediatría. Hospital General Universitario de Alicante
b Departamento de Salud Pública. Universidad Miguel Hernández, San Juan de Alicante. España
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Introductión

La indicación de las distintas pruebas de imagen en el traumatismo craneoencefálico (TCE) pediátrico, y en especial la radiografía de cráneo, es motivo de controversia

Objetivo

Evaluar efectividad de la radiografía en el manejo del TCE en edad pediátrica. Para ello se tratará de determinar su valor predictivo en la detección de lesiones intracraneales, independientemente de la sintomatología y la exploración clínica del paciente

Material y métodos

Tras realizar una revisión de la literatura médica (MEDLINE), y otros recursos de búsqueda disponibles en internet, se seleccionaron los trabajos limitados a edad pediátrica (0–18 años) que aportaran información sobre el rendimiento diagnóstico de la radiografía de cráneo en el TCE. Se recogieron el origen y las características de la población en estudio, y las posibles limitaciones de diseño

Resultados

Se seleccionaron 12 trabajos originales, tres de los cuales se referían a menores de 2 años. Se encontraron diferencias en el origen de las poblaciones muestrales, prevalencia de lesión intracraneal y fractura de cráneo, gravedad de los traumatismos incluidos, y en los criterios de realización de pruebas de imagen

Conclusiones

La escasa comparabilidad entre los artículos dificulta la evaluación del rendimiento de la radiografía de cráneo. Aunque se admite su utilización ante algunas circunstancias en el grupo de menores de 2 años, los datos obtenidos confieren un escaso valor a la realización sistemática de radiografía en la valoración del traumatismo craneal en edad pediátrica. La tomografía computarizada constituye la prueba de referencia ante la presencia de síntomas o signos de posible lesión neurológica

Palabras clave:
Traumatismo craneoencefálico
Radiografía de cráneo
Edad pediátrica
Revisión de la literatura
Introduction

The indication of distinct imaging studies in pediatric head trauma, and especially the use of skull radiography, is controversial

Objective

To assess the effectiveness of skull radiography in the management of head trauma in pediatric patients. To do this, we aimed to determine the predictive value of this procedure in detecting intracranial injuries, independently of patients' symptoms and clinical examination

Material and methods

We performed a review of the medical literature (MEDLINE) and of other resources available for searching biomedical information. Studies limited to pediatric patients (0–18 years old) that provided information on the diagnostic utility of skull radiography in head injury were selected. The source and characteristics of the populations studied and potential design limitations were taken into account

Results

Twelve original studies were selected, three of which were performed in children younger than two years old. Differences were found in the origin of the sample populations, the prevalence of intracranial injury and skull fracture, the severity of the trauma included, and in the criteria for performing imaging tests

Conclusions

Because of the limited comparability of the articles, the usefulness of skull radiography was difficult to assess. Although the use of this technique is accepted in some circumstances in patients younger than two years old, the data obtained assign little value to the systematic use of radiography to assess head trauma in pediatric patients. Head computed tomography is indicated when symptoms or signs of possible neurological injury are present

Key words:
Head injury
Skull radiography
Pediatric age group
Literature review
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Bibliografía
[1.]
B. Jennet.
Epidemiology of head injury.
Arch Dis Child, 78 (1998), pp. 403-406
[2.]
O. Papazian, I. Alfonso.
Traumatismos craneoencefálicos en niños y adolescentes. Epidemiología y prevención.
Rev Neurol (Barc), 24 (1996), pp. 1398-1407
[3.]
F. Masson, L.R. Salmi, P. Maurette.
Particularités des traumatismes craniens chez les enfants: Epidemiologie et suivi à 5 ans.
Arch Pédiatr, 3 (1996), pp. 651-660
[4.]
R. Dacey, A. Wayne, R. Rimel, R. Winn, J. Jane.
Neurosurgical complications after apparently minor head injury. Assessment of risk in a series of 610 patients.
J Neurosurg, 65 (1986), pp. 203-210
[5.]
S.J. Masters.
Evaluation of head trauma: Efficacy of skull films.
Am J Roentgenol, 135 (1980), pp. 539-547
[6.]
D.B. Hacney.
Skull radiography in the evaluation of acute head trauma: A survey of current practice.
Radiology, 181 (1991), pp. 711-714
[7.]
P.A. Hofman, P. Nelemans, G.J. Kermerink, J.T. Wilmink.
Value of radiological diagnosis of skull fracture in the management of mild head injury: Meta-analysis.
J Neurol Neurosurg Psychiatry, 68 (2000), pp. 416-422
[8.]
D. Cheung, M. Kharasch.
Evaluation of the patient with closed head trauma: An evidence based approach.
Emerg Med Clin North Am, 12 (1999), pp. 9-21
[9.]
D. Lloyd, H. Carty, C. Patterson, D. Roe.
Predictive value of skull radiography for intracranial injury in children with blunt head injury.
[10.]
K.S. Quayle, D.M. Jaffe, N. Kuppermann, et al.
Diagnostic testing for acute head injury in children: When are head computed tomography and skull radiographs indicated?.
Pediatrics, 99 (1997), pp. E11
[11.]
D.S. Greenes, S.A. Schutzman.
Occult intracranial injury in infants.
Am Emerg Med, 32 (1998), pp. 680-686
[12.]
M.R. Klauber, L.F. Marshall, T.G. Luerssen, R. Frankowski, K. Tabaddor, H.M. Eisenberg.
Determinants of head injury mortality: Importance of the low risk patient.
Neurosurgery, 24 (1989), pp. 31-36
[13.]
S.A. Schutzman, P.D. Barnes, M. Mantello, R.M. Scott.
Epidural hematomas in children.
Ann Emerg Med, 22 (1993), pp. 535-541
[14.]
J.M. Seelig, D.P. Becker, J.D. Miller, R.P. Greenberg, J.D. Ward, S.C. Choi.
Traumatic acute subdural hematoma: Major mortality reduction in comatose patients treated within four hours.
N Engl J Med, 304 (1981), pp. 1511-1518
[15.]
A.L. Cochrane.
Effectiveness and Efficiency.
Random Reflections on Health Services,
[16.]
S.R. Shackford, S.L. Wald, S.E. Ross, et al.
The clinical utility of computed tomographic scanning and neurologic examination in the management of patients with minor head injuries.
J Trauma, 33 (1992), pp. 385-394
[17.]
R.L. Davis, N. Mullen, M. Makela, J.A. Taylor, W. Cohen, F.P. Rivara.
Cranial computed tomography scans in children after minimal head injury with loss of consciousness.
Ann Emerg Med, 24 (1994), pp. 640-645
[18.]
J.M. De Villasante, J.M. Taveras.
Computed tomography (CT) in acute head trauma.
Am J Roentgenol, 126 (1976), pp. 765-767
[19.]
M. Haydel, C. Preston, T. Mills, S. Luber, E. Blaudeau, P. Deblieux.
Indications for computed tomography in patients with minor head injury.
N Engl J Med, 343 (2000), pp. 100-105
[20.]
R. Dacey, W. Alves, R. Rimel, R. Winn, J. Jane.
Neurosurgical complications after apparently minor head injury.
J Neurosurg, 65 (1986), pp. 203-210
[21.]
J. Leonidas, W. Ting, A. Binkiewicz, R. Vaz, M. Scott, S. Pauker.
Mild head trauma in children: When is a roentgenogram necessary?.
Pediatrics, 69 (1982), pp. 139-143
[22.]
R. Jaeschke, G.H. Guyatt, D.L. Sackett.
for the Evidence-Based Medicine Working Group.
User's guide to the medical literature, III: How to use an article about a diagnostic test: Are the results of the study valid? JAMA, 271 (1994), pp. 389-391
[23.]
J. Homer C, L. Kleinman.
Technical report: Minor head injury in children.
Pediatrics, 104 (1999), pp. e78
[24.]
K. Gruskin, S. Schutzman.
Head trauma in children younger than 2 years.
Are there predictors for complications? Arch Pediatr Adolesc Med, 153 (1999), pp. 13-20
[25.]
D.S. Greenes, S.A. Schutzman.
Clinical indicators of intracranial injury in head-injured infants.
Pediatrics, 104 (1999), pp. 861-867
[26.]
S.P. Ros.
Are skull radiographs useful in the evaluation of asymptomatic infants following minor head injury?.
Pediatr Emerg Care, 8 (1992), pp. 328-330
[27.]
B. Simon, P. Letourneau, E. Vitorino, J. McCall.
Pediatric minor head trauma: Indications for computed tomographic scanning revisited.
J Trauma, 51 (2001), pp. 231-238
[28.]
M. Mandera, T. Wencel, P. Bazowski, J. Krauze.
How should we manage children after minor head injury?.
Childs Nerv Syst, 16 (2000), pp. 156-160
[29.]
J. Schunk, J. Rodgerson, G. Woodward.
The utility of head computed tomographic scanning in pediatric patients with normal neurologic examination in the emergency department.
Pediatr Emerg Care, 12 (1996), pp. 160-165
[30.]
J. Benito, S. Mintegui, J. Sánchez, M. Martínez, M. Fernández.
Traumatismo craneal en la infancia: ¿permite la clínica seleccionar los pacientes en alto o bajo riesgo de presentar una lesión intracraneal?.
An Esp Pediatr, 48 (1998), pp. 122-126
[31.]
A. Legido, J. Jordan, M. Vega, J. Calvo, M.J. Esparza, L. Canedo, et al.
Utilidad de las radiografías de cráneo en los traumatismos craneoencefálicos de la infancia.
An Esp Pediatr, 22 (1985), pp. 359-369
[32.]
A. Murgio, F. Andrade, M. Sánchez, S. Boetto, K. Leung.
International multicenter study of head injury in children.
Childs Nerv Syst, 15 (1999), pp. 318-321
[33.]
B. Rosenthal, I. Bergman.
Intracranial injury after moderate head trauma in children.
J Pediatr, 115 (1989), pp. 346-350
[34.]
D. Greenes, S. Schutzman.
Infants with isolated skull fracture: What are their clinical characteristics, and do they require hospitalization?.
Ann Emerg Med, (1997), pp. 253-259
[35.]
S.A. Shane, S.M. Fuchs.
Skull fractures in infants and predictors of associated intracraneal injury.
Pediatr Emerg Care, 13 (1997), pp. 198-203
[36.]
A. Dietrich, M. Bowman, M. Ginn-pease, E. Kosnik, D. King.
Pediatric head injuries.
Can clinical factors reliably predict an abnormality on computed tomography? Ann Emerg Med, 22 (1993), pp. 1535-1540
[37.]
P. Macpherson, E. Teasdale.
Can computed tomography be relied upon to detect skull fractures?.
Clin Radiol, 40 (1989), pp. 22-24
[38.]
G.E. Kraus, R.D. Bucholz, K.R. Smith, E.E. Awwad.
Open depressed skull fracture missed on computed tomography: A case report.
Am J Emerg Med, 9 (1991), pp. 34-36
[39.]
D. Frush, S. O'Hara, M. Kliewer.
Pediatric imaging perspective: acute head trauma Is skull radiography useful?.
J Pediatr, 132 (1998), pp. 553-554
[40.]
J. Glasgow, S. McGovern.
Imaging the less seriously head injured child.
Arch Dis Child, 82 (2000), pp. 333-335
[41.]
S.A. Schutzman, D.S. Greenes.
Pediatric minor head trauma.
Ann Emerg Med, 37 (2001), pp. 65-74
[42.]
W.A. Bonadio, D.S. Smith, S. Hillman.
Clinical indicators of intracranial lesion on computed tomographic scan in children with parietal skull fracture.
Ajdc, 143 (1989), pp. 194-196
[43.]
G.M. Teasdale, G. Murray, E. Anderson, et al.
Risks of acute traumatic intracranial haematoma in children and adults: Implications for managing head injuries.
Bmj, 300 (1990), pp. 363-367
[44.]
J. Kraus, A. Rock, P. Hemyari.
Brain injuries among infants, children, adolescents, and young adults.
Ajdc, 144 (1990), pp. 684-691
[45.]
S.A. Schutzman, P. Barnes, A. Duhaime, D. Greenes, C. Homer, D. Jaffe, et al.
Evaluation and management of children younger than two years old with apparently minor head trauma: Proposed guidelines.
Pediatrics, 107 (2001), pp. 983-993
[46.]
P.K. Kleinman, M.R. Spevak.
Soft tissue swelling and acute skull fractures.
J Pediatr, 121 (1992), pp. 737-739
[47.]
H. Le Hors-Albouze.
Traumatismes crâniens dits bénins de l'enfant: Surveillance clinique ou tomodensitométrie cérébrale systématique?.
Arch Pediatr, 10 (2003), pp. 82-86
[48.]
Committee on Quality Improvement,American Academy of Pediatrics.
Commission on Clinical Policies and Research, American Academy of Family Physicians. The management of minor head injury in children.
Pediatrics, 104 (1999), pp. 1407-1415
[49.]
J.B. Coombs, R.L. Davis.
A synopsis of the American Academy of Pediatrics' practice parameter on the management of minor closed head injury in children.
Pediatr Rev, 21 (2000), pp. 413-415
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