Epidemiology of children with head injury: a national overview
L Trefan1, R Houston2, G Pearson3
1College of Biomedical and Life Sciences, School of Medicine, Cardiff University, Cardiff, Wales, UK.
Insights
This study analyzed head injuries in 5700 children across the UK, finding falls were the most common cause. The data highlights needs for targeted prevention strategies for pediatric head trauma.
Area of Science:
- Pediatric Traumatology
- Epidemiology of Injury
- Public Health
Background:
- The National Confidential Enquiry investigated the epidemiology of pediatric head injuries requiring hospital admission.
- Understanding injury patterns is crucial for effective prevention and healthcare planning.
Purpose of the Study:
- To describe the characteristics and outcomes of children admitted to UK hospitals with head injuries.
- To identify causal mechanisms, demographics, and associated risk factors for pediatric head trauma.
Main Methods:
- A descriptive analysis of 5700 children (<15 years) admitted with head injury from 216 UK hospitals between September 2009 and February 2010.
- Data collection involved standard proformas, focusing on causal mechanisms, demographics, neurological status, CT findings, and outcomes at 72 hours.
Main Results:
- Falls were the most common cause (62.1%), particularly in children under 5. Sports incidents and motor vehicle accidents were also significant causes.
- A notable association was found between head injury and social deprivation (p<0.01).
- Of 1734 CT scans, 30.9% were abnormal, revealing skull fractures or intracranial injuries.
Conclusions:
- The findings underscore the need for targeted, age-specific head injury prevention strategies for children.
- This data serves as a baseline for evaluating the impact of trauma networks and national guidelines on pediatric head injury management.
Background:
The National Confidential Enquiry describes the epidemiology of children admitted to hospital with head injury.
Method:
Children (<15 years old) who died or were admitted for >4 h with head injury were identified from 216 UK hospitals (1 September 2009 to 28 February 2010). Data were collected using standard proformas and entered on to a database. A descriptive analysis of the causal mechanisms, child demographics, neurological impairment, CT findings, and outcome at 72 h are provided.
Results:
Details of 5700 children, median age 4 years (range 0-14.9 years), were analysed; 1093 (19.2%) were <1 year old, 3500 (61.4%) were boys. There was a significant association of head injury with social deprivation 39.7/100 000 (95% CI 37.0 to 42.6) in the least deprived first quintile vs. 55.1 (95% CI 52.1 to 58.2) in the most deprived fifth quintile (p<0.01). Twenty-four children died (0.4%). Most children were admitted for one night or less; 4522 (79%) had a Glasgow Coma Scale score of 15 or were Alert (on AVPU (Alert, Voice, Pain, Unresponsive)). The most common causes of head injury were falls (3537 (62.1%); children <5 years), sports-related incidents (783 (13.7%); median age 12.4 years), or motor vehicle accidents (MVAs) (401 (7.1%); primary-school-aged children). CT scans were performed in 1734 (30.4%) children; 536 (30.9%) were abnormal (skull fracture and/or intracranial injury or abnormality): 269 (7.6%) were falls, 82 (10.5%) sports related and 100 (25%). A total of 357 (6.2%) children were referred to social care because of child protection concerns (median age 9 months (range 0-14.9 years)).
Conclusions:
The data described highlight priorities for targeted age-specific head injury prevention and have the potential to provide a baseline to evaluate the effects of regional trauma networks (2012) and National Institute of Health and Care Excellence (NICE) head injury guidelines (2014), which were revised after the study was completed.
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