International Multicenter Study of Head Injury in Children. ISHIP Group
A Murgio1, F A Andrade, M A Sanchez Muñoz
1Abel@statics.com.ar
Insights
This study analyzed pediatric head injuries (HI) across five countries, finding minor HI cases often received excessive imaging and prolonged hospitalization despite low brain damage rates. New treatment guidelines for minor HI are recommended.
Area of Science:
- Pediatric Traumatology
- Epidemiology
- Neurology
Background:
- Head injury (HI) is a significant concern in pediatric populations.
- Understanding epidemiological factors, clinical presentation, and outcomes is crucial for effective management.
Purpose of the Study:
- To evaluate epidemiological factors in the acute phase of pediatric head injury.
- To analyze clinical and radiological risk factors, management, and outcomes 7-30 days post-trauma.
- To identify areas for improved treatment guidelines, particularly for minor HI.
Main Methods:
- A prospective, descriptive study involving 2478 children (0-15 years) with head injury across five countries.
- Data collected from clinical records, including neurological evaluation (Glasgow Coma Scale, Glasgow Paediatric Coma Score), symptoms, skull X-rays, and CT scans.
- Analysis of clinical and radiological risk factors, management strategies, and patient outcomes.
Main Results:
- The study included 2478 children, with 60.9% boys and 39.1% girls. 42.7% required hospitalization.
- Skull fractures occurred in 11.8% and 6.4% of CT scans were abnormal. Minor HI comprised 56.4% of cases.
- Lethality rate was 1.6%. Minor HI patients underwent the most skull X-rays and had prolonged hospital stays, despite the lowest incidence of brain damage.
Conclusions:
- Preliminary data suggest a need for revised treatment guidelines for minor head injuries in children.
- Current management of minor HI may involve unnecessary diagnostic imaging and extended hospital admissions.
- Further analysis is planned to fully elucidate risk factors and optimize pediatric head injury care.
Abstract:
With the object of evaluating different epidemiological factors in the acute phase of head injury (HI) in the pediatric age group in five countries (Argentina, Brazil, France, Hong-Kong and Spain), we carried out a prospective and descriptive study, in which we analyzed the clinical and radiological risk factors versus management and outcome 7-30 days after trauma. We included all children seen in the emergency department and hospitalized who were aged between 0 and 15 years and had sustained HI. Data were compiled from the clinical records and analyzed for neurological evaluation with the Glasgow Coma Scale (GCS) and the Glasgow Paediatric Coma Score (GPCS), and also by means of dynamics, symptoms, skull X-rays, CT scans. The total of 2478 patients enrolled in the study was made up of 60.9% boys and 39.1 % girls. Age distribution was as follows: 55.2% aged 0-4 years; 28.3% aged 5-9 years, and 16.4% aged 10-15 years. Most (75.3%, or 1768) of these patients completed follow-up. The total sample included 1058 children (42.7%) who required hospitalization. Skull fractures were identified in 11.8% (298) of the cases, and 6.4% (158) of CT scans were pathologic. Minor HI accounted for 56.4% of these children, moderate HI for 38.9%, and severe HI for the remaining 4.7%. The lethality rate was 1.6%. Our preliminary data reveal that it is very important for new guidelines on the treatment of minor HI to be prepared, because patients with minor HI had undergone the most skull X-rays and also most frequently been admitted to hospital for unnecessarily long periods of time, though the incidence of brain damage (1.6%) was lowest in this group of the study population. We intend to carry out a full analysis of the various risk factors at the end of the study.
