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Avoidable factors contributing to death of children with head injury
P M Sharples1, A Storey, A Aynsley-Green
1Department of Child Health, University of Newcastle upon Tyne.
Insights
Potentially avoidable factors contributed to death in 32% of children with head injuries. Improving management and neurosurgical referral guidelines for pediatric head trauma is crucial.
Area of Science:
- Pediatric Traumatology
- Public Health
- Epidemiology
Background:
- Head injuries are a leading cause of death in children.
- Understanding contributing factors to mortality is essential for prevention.
Purpose of the Study:
- To determine the incidence of potentially avoidable complications leading to death in children with head injuries.
- To identify areas for improvement in pediatric head injury care.
Main Methods:
- Retrospective review of child deaths (1979-1986) with head injuries.
- Utilized data from national statistics, hospital records, coroners, and necropsy reports.
- Analysis focused on potentially avoidable factors in pre-hospital and in-hospital deaths.
Main Results:
- Head injury was a primary cause of death in children over 1 year old.
- Potentially avoidable factors contributed to death in 32% of cases (81 out of 255 deaths).
- Inadequate airway management and delayed diagnosis of intracranial hemorrhage were key factors.
Conclusions:
- Urgent revision of regional guidelines for pediatric head injury management is needed.
- Improved indications for neurosurgical referral and care system audits are recommended.
- Focus on timely diagnosis and appropriate airway management can reduce mortality.
Objective:
To assess the incidence of potentially avoidable complications contributing to death of children with head injuries.
Design:
Retrospective review of children who died with head injuries from 1979 to 1986 from data of the Office of Population Censuses and Surveys, Hospital Activity Analyses, case notes, coroners' records, and necropsy reports.
Setting:
District general hospitals and two regional neurosurgical centres in Northern region.
Results:
255 Children died from head injury in the region, the mortality being 5.3 per 100,000 children per year. Head injury was the single most important cause of death in children aged greater than 1 year, accounting for 15% of deaths in children aged 1-15 years and a quarter for those aged 5-15 years. 121 Potentially avoidable factors possibly or probably contributing to death occurred in 81 children (32%). Half the children (125) died before admission, 27 of whom (22%) had potentially avoidable factors possibly or probably contributing to death, and 130 died after admission, 54 of whom (42%) had 93 such factors, which included failure of diagnosis or delayed recognition of intracranial haemorrhage or associated injury, inadequate management of the airways, and poor management of the transfer between hospitals.
Implications:
Regions should revise urgently their guidelines for optimal management and indications for neurosurgical referral to include children with severe head injuries and audit their systems of care for all patients with head injuries.