In this study, we aimed to determine the relationship between the levels of leukocyte, which is one of the acute phase reactants, in isolated head trauma patients during admission, and age, gender, trauma etiology, symptoms, GCS, and brain CT findings.
Childhood head injuries are most common in men 62.6% . In our study, in accordance with the literature we found that there was a 64.2% male patient. In the etiology of head injuries, falls are in the first place, and then traffic accidents come . In our study, falls were the most common cause with 65.3%. GCS is used as the most common assessment to measure the clinical level of brain injury in patients with head trauma . Approximately 80% of patients who apply to the emergency department with head trauma constitute, whose GCS was 14 ≥. In our study, we found that GCS was 14 ≥ that 69.4% of our patients.
In determining intracranial pathology in patients with head injury BT is still the most important diagnostic method . Various protocols, such as PECARN, CATCH and CHALICE, have been identified for diagnosis and monitoring in children presenting with head trauma [7, 8]. According to PECARN, which is the most commonly used of these protocols, brain CT is recommended in patients whose GCS is 13≤. In patients who had GCS was 14 ≥, brain CT is recommended if there are signs of a skull fracture or if there is loss of consciousness, vomiting, severe headache, or a dangerous trauma mechanism. Brain CT is not recommended in patients who had GCS was 14 ≥ and those who do not show these findings . Nevertheless, indications of brain CT for diagnostic purposes still remain a controversial subject. Because it is difficult to evaluate the anamnesis and clinical examination findings in children under two years of age, physicians often request brain CT considering the possibility of brain damage . Brain CT frequency has increased significantly in patients with head trauma in recent years . Following after withdrawn brain CTs, the risk of malignancies occurence associated with ionizing radiation in children increases . Exposure to ionizing radiation during CT scans has been shown to increase the risk of brain tumor and leukemia per mGy in children by 0.016 and 0.033, respectively . Also in another study which was made, radiation exposure after CT extractions in children creates a higher risk of cancer compared to adults . Beside this, the agitation and be moving of young children can make CT shooting difficult. For this reason, physicians have to use sedative drugs in patients with head trauma. The use of these drugs carries the risks of respiratory or cardiovascular complications. In a study which was made, it was stated that clinical examination findings did not reduce brain CT request alone in head traumas, long-term observation is required to make a good decision .
In our study, we found that many patients who had GCS 14 according to PECARN and who did not show symptoms had CT withdrawn, although not recommended in the protocol. This indicates that there should be guiding biomarkers alongside the clinical examination. Traumatic brain injury is associated with increased serum catecholamine levels. With the activation of the systemic response after trauma, the inflammatory process begins. In the evaluation of trauma patients, parameters such as acute phase reactants, cytokines and lactate levels related to the systemic response of the organism are used . Inflated WBC values are generally considered to be non-specific indicators of infection, inflammation, tissue necrosis, bleeding, or stressful situations. WBC is one of the first inflammatory parameters and that increase in inflammation . Acar et al. investigated the usability of WBC as a screening test with the brain in patients with simple head injury and determined that WBC value could be a statistically significant variable with the presence of pathology in brain CT . In our study, the presence of pathology in the brain CT in the patients and the presence of leukocytosis were statistically significant. However, in 123 (87.2%) of the patients with normal brain CT, which constitutes the majority of cases, leukocytosis was not detected. In another study, it was shown that the number of WBCs of patients with severe head trauma was significantly high . In a study showing the relationship between blood WBC levels and GCS, the presence of leukocytosis was found to be significant in patients with low GCS . In our study, competable with the literature, in patients with a GCS score of 13 ≤ the presence of leukocytosis was significant (p = 0.001). When we searched the literature, we found that there was no relationship study between the presence of symptoms and leukocytosis in patients with head trauma aged 0–18 years. In our study, presence of leukocytosis was statistically significant, in the event that one or more of the symptoms of vomiting, headache, temporary loss of consciousness at the time of the event, dizziness.