| Summary: | A research report presented to the
Faculty of Health Sciences, University of the Witwatersrand
In partial fulfillment of requirements for the degree
of
Masters of Science in Medicine in Emergency Medicine.
June2017. === Head injuries are among the most common reasons children visit Emergency
Departments (ED) worldwide (5). Head injuries seen in the ED can be categorized
as minor, moderate or severe, as defined by the Glasgow Coma Scale (GCS) (3).
Minor head injuries (MHI) are defined as a GCS of 13 to15 (6). The majority (>80%)
of head injuries presenting in the ED, can be classified as MHI (5). When dealing
with children who sustained a MHI, it is a challenge to determine whether there might
be a potentially life threatening underlying injury to the brain (5,8,9).
The introduction of CT scan greatly improved the evaluation and management of
MHI. The advantages include high accuracy and it is relatively fast to determine
potential life threatening intracranial pathology. Disadvantages include cost, as well
as high radiation doses associated with CT scans (8). To help decide whether a CT
scan would be useful/diagnostic, a number of international validated CT scan
rules/guidelines were developed (14,26). Effort should be made to reduce the
number of CT scans done in the ED.
The aim of this study was to look at:
• The population of children that presented to the private Emergency
Department in the North of Pretoria with the history of minor blunt
head injury over a 12-month period.
• The management of children who presented with a minor blunt head
injury in the Emergency Department studied.
• Any evidence of an International recognized guideline used in the
decision to perform a CT scan in the Emergency Department
studied.
• The incidence of positive CT scans that were done in the Emergency
Department studied.
vi
• Which of the international validated guidelines are best suited for
the children that present to the Emergency Department studied in
terms of compliance.
The study design was retrospective. The timeframe of data collected was 12
months. The sample size was 173 children.
The results showed that the population demographics of the children as well as the
etiology and management of the minor head injuries that presented in the unit
studied was comparable to most internationally recognized studies, both in
developed and developing countries. In the emergency department studied, there
was no evidence found to prove that validated guidelines were used in the decision
process to order a CT scan or not.
We as emergency department doctors in South Africa need a cost effective,
safe and sensitive guideline that is easy to incorporate in a private emergency
department setting. We have to consider over investigation with the associated
radiation risks of doing CT scans. We should also prevent under investigation
and missing clinically significant intracranial pathology in minor head injuries.
South Africa is a developing country and therefore financial constraints are a
major factor in decision process of the management of all patients, including
children with minor head injuries. Incorporating all data obtained and audited,
as well as the international validated guidelines studied, it can be concluded
that the PECARN Rule for minor head injuries would best be incorporated in
the emergency department studied. === LG2018
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