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[Head injuries in children. Considerations on 3,715 consecutive cases]
Insights
Most pediatric head injuries are minor, often due to lack of supervision. Road accidents are a major cause of severe head trauma in children, highlighting the need for prevention and prompt treatment.
Area of Science:
- Pediatric Surgery
- Emergency Medicine
- Neurotrauma
Context:
- A 3-year prospective study analyzed 3715 pediatric head injury cases admitted to a children's hospital emergency department.
- The study focused on immediate management, diagnostic workup, and clinical outcomes of head injuries in patients aged 5 days to 14 years.
Purpose:
- To evaluate the epidemiology, diagnostic approaches, and clinical outcomes of pediatric head injuries.
- To identify risk factors and emphasize the importance of managing secondary cerebral damage.
Summary:
- 91% of head injuries were minor, with only 1.5% requiring hospital admission.
- Cranial CT scans revealed pathological findings in 23.9% of cases where performed.
- Lack of adult supervision and road accidents were identified as primary causes of head injuries.
Impact:
- Findings underscore the need for targeted prevention strategies, particularly addressing supervision and road safety.
- Highlights the critical importance of recognizing and managing potentially severe, non-immediate secondary cerebral damage in pediatric head trauma.
Background:
The authors present their personal experience of 3715 cases of head injury in pediatric patients, occurring during the last three years (1997-1999), admitted to the Emergency ward at the "Anna Meyer" children's hospital in Florence.
Methods:
A prospective study was made, starting from the evaluation made by the paediatric surgeon and following the subsequent diagnostic and clinical course. Depending on the severity of injury, this took the form of immediate discharge with a written sheet of instructions, "short observation" (up to 12 hours) in an Emergency ward and/or admission to neurosurgery or general medicine or to intensive care. The authors also analyse the diagnostic and instrumental tests carried out at the various stages (cranial X-ray, direct cranial CT, EEG) and the specialist consultations required (neurosurgery, neurology, paediatrics, resuscitation). Data for injured children transferred from other hospitals for neurosurgery were excluded from the study which only included patients examined primarily at our hospital. If admitted for more than 48 hours, a neurosurgical outpatient check-up was programmed one week later. In more severe cases, patients were admitted to day hospital between six months and one year later.
Results:
Injuries were minor in 91% of cases and the age of patients ranged between 5 days and 14 years; moreover, 60% of the patients observed were male. Only 1.5% of cases seen in Emergency were admitted to hospital and 8.4% of all head injuries, with a total stay of between 1 and 6 days. There were 4 deaths in severely polytraumatised patients. There was only one case of firearm injury which was not fatal. Head X-rays were performed in 13.4% of patients showing evidence of fracture in 19.1% of cases. Direct cranial CT was performed in 10.2% of cases with pathological findings in 23.9% of cases. Neurosurgery was performed in one of the 5.9% patients admitted to hospital. The late sequelae to head injury included one case of epilepsy that occurred 7 months after injury.
Conclusions:
Anamnesis showed that the most frequent reason leading to head injury was lack of adult supervision and that the majority of severe injuries were caused by road accidents, both as pedestrians and as passengers. Lastly, the authors emphasise the importance of recognising and correctly treating so-called secondary cerebral damage, which has a non-immediate onset but is potentially severe, and identifying the risk factors for head injury in order to reduce the incidence and severity.
