Pre-ambulatory infants with head trauma: a three-year retrospective study

(i) To present the severity and documented mechanism of injury and clinical features of all infants less than 6 months old who presented with head trauma to a paediatric emergency department over a 3-year period; (ii) to evaluate the quality of their assessment; and (iii) to present the clinical features of those referred for assessment of possible inflicted injury.

Demographics, documented mechanism of injury, clinical features and management were retrospectively collected from the case notes. Adequacy of assessment was judged in terms of documentation of the history and examination, investigations performed and nature of any observation period.

Two hundred and fifty-one cases were analysed. Twenty-seven (11%) had sustained a major injury. Infants reported as dropped by a care giver were significantly more likely to have sustained a major injury. Infants with major injury were more likely to have vomited (P < 0.05), or to have external signs of injury (P < 0.0005). All patients with major injury had symptoms or signs or both. One hundred and thirty-four infants had been inadequately assessed. Fourteen infants were referred for possible inflicted injury (confirmed in six cases).

The mechanism of injury and clinical findings can provide some guide as to the likelihood of an infant having sustained a major injury after head trauma. The assessment of infants with head trauma could be improved if currently available guidelines for children under 2 years old were adopted. However, infant-specific guidelines should be developed.