Utility of computed tomography of the head following head trauma in boys with haemophilia

The most serious site of bleeding for patients with haemophilia is the central nervous system. Intracranial haemorrhage (ICH) in patients with haemophilia can occur spontaneously or following mild head trauma however no guidelines exist for the approach to these patients. The goal of this review was...

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Bibliographic Details
Published in:Haemophilia : the official journal of the World Federation of Hemophilia 2007-09, Vol.13 (5), p.560-566
Main Authors: WITMER, C. M., RAFFINI, L. J., MANNO, C. S.
Format: Article
Language:English
Subjects:
bleeding disorders
Child
Child, Preschool
computed tomography
Craniocerebral Trauma - complications
haemophilia
head trauma
Hemophilia A - complications
Humans
Infant
intracranial haemorrhage
Intracranial Hemorrhages - diagnostic imaging
Intracranial Hemorrhages - etiology
Male
Retrospective Studies
Tomography, X-Ray Computed - utilization
Treatment Outcome
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Summary:The most serious site of bleeding for patients with haemophilia is the central nervous system. Intracranial haemorrhage (ICH) in patients with haemophilia can occur spontaneously or following mild head trauma however no guidelines exist for the approach to these patients. The goal of this review was to determine the utility of screening computed tomography (CT) of the head for patients with haemophilia who experience head trauma and to determine if the use of clinical criteria could allow a selective approach to radiographic imaging. In a retrospective study we reviewed the management of head trauma in a cohort of paediatric patients with haemophilia in a single institution. The cohort included males, ages birth to 18 years with haemophilia A or B who were followed at the haemophilia treatment center at The Children’s Hospital of Philadelphia from 1994 to 2005. Between the years of 1994 and 2005, 97 patients were evaluated for head trauma for a total of 374 emergency department visits. There were 295 head CT scans performed to identify 9 (3%) episodes of intracranial bleeding. Fifty‐six per cent of the patients with intracranial bleeding had no clinical signs or symptoms. The clinical outcome was excellent in all cases with no deaths or reported morbidity. In this cohort, a lack of symptoms and a normal neurological exam did not exclude ICH, especially in patients with severe haemophilia who were evaluated soon after a mild head trauma event suggesting the utility of early head CT imaging.
ISSN:1351-8216
1365-2516
DOI:10.1111/j.1365-2516.2007.01546.x