Abstract
Öz.
Amaç:Çocukluk yaş grubunda morbidite ve mortalitenin en sık sebebi kafatravmalarıdır. Kafa travması olan çocuklarda beyin tomografisi için çeşitli protokoller tanımlanmıştır. Bunlarda klinik değerlendirmeler ön plana çıktığı için acil servislerde uygunsuz, abartılı hasta şikayetleri veya aşırı iş yükü yoğunluğu nedeniyle beyin tomografisi çekimi için karar vermek zor olabilir. Çalışmamızda minör pediatrik kafa travmalı hastalarda, beyin tomografisi çekimine karar verme aşamasında nötrofil-lenfositoranı ve trombosit-lenfosit oranının yol gösterici olup olamayacağını araştırmayı amaçladık.
Materyal ve Metod: Bu retrospektif çalışmaya beyin tomografisi taramalarında patolojisi olan 96 hasta(grup I), yaşı ve cinsiyet bakımından bu gruba denk olan normal sağlıklı ve beyin tomografisi sonucu olan 99 (grup II) çocuk dâhil edildi. Grup 1 medikal ve cerrahi tedavi almalarına göre iki gruba ayrıldı. Hematolojik parametreler rutin laboratuvar yöntemleri ile çalışıldı. Her katılımcıda rutin hematolojik parametreler incelendi.
Bulgular: Gruplar karşılaştırıldığında, nötrofil, lökosit, nötrofil-lenfosit oranı ve trombosit-lenfosit oranı grup I’ de grup 2’ye göre anlamlı derecede yüksekti (tümü için p<0.05). Alt grup analizlerinde; grup I’ de cerrahi tedavi gereken hastalarda nötrofil-lenfosit oranı ve trombosit-lenfosit oranı medikal izlem gerektiren hastalara göre istatiksel olarak anlamlı derecede yüksekti (tümü için p<0.05). Receiver operating characteristic analizi nötrofil-lenfosit oranı ve trombosit-lenfosit oranının minor kafatravmasında patoloji ve cerrahiyi öngörmede önemli olabileceğini göstermektedir.
Sonuç: Minör kafa travmalarında nötrofil-lenfosit oranı ve trombosit-lenfosit oranının yüksekliği beyin tomografisi çekimi gerekliliği için yol gösterici olabilir. Ek olarak, bu parametreler patoloji saptanması durumunda uygulanacak tedavi yöntemini seçmede de yardımcı olabilir.
References
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- 10.Acar E, Demir A, Alatas ÖD, Beydilli H, Yıldırım B, Kırlı U, et al.Evaluation of hematological markers in minor headtrauma in the emergency room. Eur J Trauma Emerg Surg. 2016;42(5):611-6.
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- 14.Balta S, Ozturk C. Theplatelet-lymphocyteratio: A simple, inexpensive and rapid prognostic marker for cardiovascular events. Platelets. 2015;26(7):680-1.
Evaluation of the Clinical Significance of Hematological Markers in Pediatric Patients Presenting to the Emergency Department with Minor Head Trauma
Abstract
Background: The most common cause of morbidity and mortality in childhood is head injuries. Various protocols have been described for brain tomography (BT) in children with head trauma. Because clinical evaluations come to thefore in these, it may be difficult to decide for brain tomography necessity due to inappropriate, exaggerated patient complaint or excessive workload intensity in emergency departments. In our study, we aimed to investigate whether neutrophil-lymphocyte ratio (NLO) and platelet-lymphocyte ratio (PLO) can be a guide in decision-making of necessity in patients with minor pediatric head trauma.
Methods:The files of 195 patients who were admitted to our hospital emergency department with an isolated minor pediatric head injury between January 1, 2015 and October 31, 2018 were retrospectively analyzed. Patients were divided into two groups according to CT result: Patients with minor pathology in CT (n = 96 patients, Group 1) and patients with normal CT results (n = 99, Group 2). Patients in group 1 were also divided into two groups according to their medical and surgical treatment. Routine hematological parameters were compared between the groups.
Results:When compared to group 2, neutrophil count, leukocyte count, NLO and PLO were significantly higher in group 1 (p <0.05, for all). In subgroup analysis; patients who required surgical treatment were significantly higher NLO and PLO levels than patients who required medical follow-up in group 1 (p <0.05 for all). In the Receiver operating characteristic (ROC) analysis, it was found that NLO ≥ 1.74 predicted minor head trauma with a sensitivity of 88% and specificity of 81% , while PLO was ≥ 108.1 predicted it with a sensitivity of 69% sensitivity and specificity of 67% .
Conclusions:The increase of NLO and PLO may be a guide for detecting the necessity of BT in minor head traumas.In addition, these parameters can also be helpful in choosing the treatment method to be applied if pathology is detected.
References
- 1.McKinlay A, Grace RC, Horwood LJ, Fergusson DM, Ridder EM, MacFarlane MR. Prevalence of traumatic brain injury among children, adolescents and young adults: prospective evidence from a birth cohort. Brain Inj 2008;22:175–81.
- 2.Morrissey K, Fairbrother H, Vazquez MN. Severe traumaticbraininjury in children: an evidence-basedreview of emergency department management [digest]. Pediatr Emerg Med Pract. 2016 Oct 22;13(10 SupplPoints&Pearls):S1-S2.
- 3.Gahtany MA. Serum LeukocyteCount (WBC) Levels as an Indicator for Severity of Traumatic Brain Injury in Saudi Arabia Patients. Egyptian Journal of Neurosurgery. 2015;30(2):145–50.
- 4.Kaya H, Sogüt O, Gokdemir MT, Albayrak L, Taskın A. The role of oxidativestatus in initial evaluation of paediatric patients with graded traumatic brain injury. Hong Kong J Emerg Med. 2013; 20(4):226–32.
- 5.Faria SS, Fernandes PC Jr, Silva MJ, Lima VC ,Fontes W , Junior RF, et al. Theneutrophil-to-lymphocyteratio: a narrativereview. Ecancermedicalscience. 2016;10:702.
- 6.Berksoy AE, Anıl M. Effectiveness of complete blood count parameters for predicting intracranial ınjury in children with minor head trauma. Sanamed 2019; 14(1): 59–65.
- 7.(8). Sahin L, KayabasM , Aras L. Prognostic Value of Leukocytosis in Pediatric Head Trauma. J Med Biomed App Sci 8 (5), 436−41.
- 8.Babl FE, Lyttle MD, Bressan S, Borland M, Phillips N, Kochar A, et al. A prospective observational study to assess the diagnostic accuracy of clinical decision rules for children presenting to emergency department safter head injuries (protocol): the Australasian Paediatric Head Injury Rules Study (APHIRST). BMC Pediatrics. 2014;14(1):148.
- 9.Shah SS, Shofer FS, Seidel JS, Baren JM. Significance of extreme leukocytosis in the evaluation of febrile children. Pediatr Infect Dis J. 2005;24(7):627-30.
- 10.Acar E, Demir A, Alatas ÖD, Beydilli H, Yıldırım B, Kırlı U, et al.Evaluation of hematological markers in minor headtrauma in the emergency room. Eur J Trauma Emerg Surg. 2016;42(5):611-6.
- 11.Roxburgh CS, McMillan DC. Role of systemic inflammatory response in predicting survival in patients with primary operable cancer. FutureOncol. 2010;6(1):149-163.
- 12.Zhang J, Ren Q, Song Y, He M, Zeng Y, Liu Z, et al. Prognostic role of neutrophil-lymphocyte ratio in patients with acute ischemic stroke. Medicine (Baltimore). 2017;96(45)
- 13.Chen W, Yang J, Li B, Peng G, Li T, Li L, et al. NeutrophiltoLymphocyteRatio as a NovelPredictor of Outcome in PatientsWith Severe Traumatic Brain Injury. J HeadTraumaRehabil. 2018;33(1):E53-E59.
- 14.Balta S, Ozturk C. Theplatelet-lymphocyteratio: A simple, inexpensive and rapid prognostic marker for cardiovascular events. Platelets. 2015;26(7):680-1.
Details
| Primary Language | Turkish |
|---|---|
| Subjects | Clinical Sciences |
| Journal Section | Research Article |
| Authors | |
| Publication Date | August 20, 2020 |
| Submission Date | July 6, 2020 |
| Acceptance Date | July 24, 2020 |
| Published in Issue | Year 2020 Volume: 17 Issue: 2 |
Harran Üniversitesi Tıp Fakültesi Dergisi / Journal of Harran University Medical Faculty