The cranial imaging results of children presenting to the pediatric emergency clinic with neurologic symptoms

The Cranial Imaging Results of Children Presenting to the Pediatric Emergency Clinic with Neurologic Symptoms The aim of this study is to determine the frequency of cranial MRI and CT scans, the distribution according to indications, abnormal physical examination findings and radiological findings, the frequency of medical or surgical interventions and their contribution to treatment. The data of pediatric patients who presented to the Istanbul University Medical Faculty's Pediatric Emergency Clinic with acute neurologic complaints and had cranial CT or MRI scanning between January 1st, 2016 and November 31st, 2017 were retrospectively analyzed via the hospital's automation system. The age, gender, date of presentation, complaint, accompanying symptoms, previously known diseases, physical examination findings, radiological reports of MRI and CT scans, neurosurgery and neurology consultation notes, diagnoses, medical or surgical interventions and inpatient records were evaluated. The total number of applications to the Istanbul University Medical Faculty Pediatric Emergency Clinic between January 1st, 2016 and November 31st, 2017 was 88786. The ages of the patients included in the study ranged from 1 month to 215 months. 428 patients, 206 male and 222 female patients had MRI scanning and 78 patients, 32 male and 46 female had CT scanning. The indications for cranial MRI were headache in 28.9%, seizure in 28.7%, acute change in consciousness in 14.8% and other reasons in 27.3%. The radiological reports were normal in 67.8% and abnormal in 32.2%. The majority of the abnormal radiological reports (78.5%) were due to important causes (infectious, ischemia or thrombosis, increase in CSF distance, hemorrhage/hematoma, tumor etc.), a small number (12%) were incidental findings and an even less number (9.4%) were previously known. According to the cranial MRI reports, 2.3% of patients were discharged after a period of observation, 8.2% were admitted as inpatients, 1.4% had surgical intervention, 7.2% had medical intervention. The indications for cranial CT scanning was seizure in 26.9%, headache in 25.6%, acute change in consciousness in 15.3% and other reasons in 32%. The radiological reports were normal in 60,2% and abnormal in 39,7%. The majority of the abnormal radiological reports (59.5%) were due to important causes (infectious, hemorrhage, dilated ventricles), a small number (10.8%) were incidental findings and some (18.9%) were previously known. According to the cranial CT reports, 7.7% of patients were discharged after a period of observation, 6.4% were admitted as inpatients and 3.8% had surgical intervention. In Istanbul University Medical Faculty's Pediatric Emergency Clinic, cranial MR and CT scanning are commonly used for the evaluation of acute neurological symptoms. Despite the fact that seizure, headache and acute change in consciousness are alarming findings, the imaging is usually reported as normal. Although history and physical examination are sufficient to rule out most of the central nervous system pathologies, imaging is needed due to cooperation difficulties with pediatric patients. Cranial MR imaging is thought be superior to CT in critical cases.