A prospective surveillance of paediatric head injuries in Singapore: a dual-centre study
Shu-Ling Chong1, Su Yah Chew2, Jasmine Xun Yi Feng3
1Department of Emergency Medicine, KK Women's and Children's Hospital, Duke-NUS Medical School, Singapore.
Insights
Motor vehicle crashes and non-accidental trauma are leading causes of severe paediatric head injuries in Singapore. Prevention efforts are crucial to reduce mortality and the need for interventions like neurosurgery.
Area of Science:
- Pediatric Emergency Medicine
- Trauma Surgery
- Public Health
Background:
- Head injuries are a significant cause of morbidity and mortality in children.
- Understanding the specific causes and outcomes of paediatric head injuries is essential for targeted prevention strategies.
Purpose of the Study:
- To investigate the causes of head injuries in children in Singapore.
- To determine the association between injury causes and mortality.
- To assess the need for airway or neurosurgical intervention in paediatric head injuries.
Main Methods:
- A prospective observational study was conducted using data from a trauma surveillance system (January 2011 - March 2015).
- Participants included children under 16 years presenting to paediatric emergency departments with head injuries requiring CT scan, admission, or resulting in death.
- The primary composite outcome was death or the need for intubation or neurosurgery.
Main Results:
- 1049 children were analyzed; 1.6% died, 5.0% required intubation, and 5.5% underwent neurosurgery.
- Motor vehicle crashes (OR 7.2) and non-accidental trauma (OR 5.8) were significantly associated with severe outcomes.
- Less than half of children involved in motor vehicle crashes were using restraints.
Conclusions:
- Motor vehicle crashes and non-accidental trauma are key contributors to poor outcomes in paediatric head injuries.
- Enhanced injury prevention initiatives and legislative compliance are vital for improving child safety.
Objective:
To study the causes of head injuries among the paediatric population in Singapore, and the association between causes and mortality, as well as the need for airway or neurosurgical intervention.
Design:
This is a prospective observational study utilising data from the trauma surveillance system from January 2011 to March 2015.
Setting:
Paediatric emergency departments (EDs) of KK Women's and Children's Hospital and the National University Health System.
Participants:
We included children aged <16 years presenting to the paediatric EDs with head injuries who required a CT scan, admission for monitoring of persistent symptoms, or who died from the head injury. We excluded children who presented with minor mechanisms and those whose symptoms had spontaneously resolved.
Primary And Secondary Outcome Measures:
Primary composite outcome was defined as death or the need for intubation or neurosurgical intervention. Secondary outcomes included length of hospital stay and type of neurosurgical intervention.
Results:
We analysed 1049 children who met the inclusion criteria. The mean age was 6.7 (SD 5.2) years. 260 (24.8%) had a positive finding on CT. 17 (1.6%) children died, 52 (5.0%) required emergency intubation in the ED and 58 (5.5%) underwent neurosurgery. The main causes associated with severe outcomes were motor vehicle crashes (OR 7.2, 95% CI 4.3 to 12.0) and non-accidental trauma (OR 5.8, 95% CI 1.8 to 18.6). This remained statistically significant when we stratified to children aged <2 years and performed a multivariable analysis adjusting for age and location of injury. For motor vehicle crashes, less than half of the children were using restraints.
Conclusions:
Motor vehicle crashes and non-accidental trauma causes are particularly associated with poor outcomes among children with paediatric head injury. Continued vigilance and compliance with injury prevention initiatives and legislature are vital.
