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Patterns of accidental craniocerebral injury occurring in early childhood
A G Thomas1, S V Hegde, R A Dineen
1Radiology Department, University Hospitals of Leicester NHS Trust, Leicester Royal Infirmary, Infirmary Square, , Leicester, UK.
Insights
Accidental head injuries in young children (0-2 years) often cause skull fractures and subdural hemorrhages but rarely lead to long-term issues. Severe brain injuries with lasting effects only occur with high-force trauma mechanisms.
Area of Science:
- Pediatric Traumatology
- Neuroradiology
- Clinical Pediatrics
Background:
- Accidental head injuries are a significant concern in infants and toddlers.
- Understanding the spectrum of intracranial injuries and their consequences is crucial for accurate diagnosis and management.
Purpose of the Study:
- To characterize intracranial injuries in children aged 0-2 years resulting from accidental head trauma.
- To correlate injury types with specific trauma mechanisms.
- To assess the clinical and neurological outcomes of these injuries.
Main Methods:
- Retrospective review of imaging and clinical data from two tertiary pediatric centers.
- Inclusion of 149 children aged 0-2 who underwent cranial CT for head injury between 2006-2011.
- Analysis of skull fractures, intracranial hemorrhages, parenchymal injuries, and neurological sequelae based on injury mechanism.
Main Results:
- Skull fractures occurred in 36% of patients, with 11% having associated subdural hemorrhage (SDH).
- Isolated subdural hematomas without fractures were also observed.
- Parenchymal brain injuries were rare, seen only in cases with high-force trauma mechanisms, and severe neurological sequelae were linked to diffuse hypoxic-ischemic damage.
Conclusions:
- Skull fractures and focal SDH are common after minor trauma in this age group, typically without long-term neurological deficits.
- Severe brain injury and significant neurological impairment are associated with severe trauma mechanisms involving substantial force.
Objective:
To describe the range of intracranial injuries encountered in 0-2-year-olds in cases of accidental head injury where the mechanism of trauma was well characterised and to assess the clinical consequences.
Design:
A retrospective review of imaging and clinical data.
Setting:
Two tertiary paediatric referral centres.
Patients:
All children aged 0-2 undergoing cranial CT as indicated by National Institute for Health and Clinical Excellence guidance for head injury from 2006 to 2011. After exclusion criteria, 149 patients were included.
Main Outcome Measures:
Rates of skull fracture, intracranial haemorrhage, parenchymal injuries and ischaemic change per type of mechanism of injury. Rates of neurological sequelae on follow-up.
Results:
Skull fractures were demonstrated in 54 (36%) patients of whom 17 (11%) had thin underlying subdural haemorrhage (SDH). Extradural haemorrhage complicated one fracture and two cases of isolated subdural haematomas were seen without skull fracture. Radiologically evident brain parenchymal injuries were present in three patients, all with mechanisms of injury involving high levels of force; severe neurological sequelae were only seen in one patient, who had diffuse hypoxic-ischaemic damage at presentation and whose (accidental) mechanism of injury involved extensive acceleration/deceleration/translational forces.
Conclusions:
Skull fractures and focal SDH are relatively common following minor trauma in this age group but in the vast majority of cases there are no long-term neurological sequelae. Conversely, diffuse brain injury with severe subsequent neurological impairment was only seen in patients with a correspondingly severe mechanism of injury.
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