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Head trauma in the haemophilic child and management in a paediatric emergency department: Descriptive study
P García Sánchez1, M Á Molina Gutiérrez1, J Martín Sánchez1
1Paediatric Emergency Department and Hematology Department, La Paz University Hospital, Madrid, Spain.
Insights
Head trauma in children with haemophilia can lead to intracranial hemorrhage (ICH). Symptomatic patients require CT scans, while asymptomatic ones need observation to manage this serious bleeding risk.
Area of Science:
- Pediatric Emergency Medicine
- Hematology
- Neurology
Background:
- Haemophilia is a common inherited bleeding disorder.
- Central nervous system bleeding is a critical concern in haemophiliacs.
Purpose of the Study:
- To characterize haemophiliac patients presenting to the ED after head trauma.
- To determine the incidence of intracranial hemorrhage (ICH) in this cohort.
Main Methods:
- Retrospective, analytical, observational study in a Pediatric ED.
- Included haemophilic patients (0-16 years) with head trauma over 6 years.
- Collected data on demographics, trauma, symptoms, prophylaxis, CT, treatment, and ED visits.
Main Results:
- Analyzed 85 episodes in 46 males; median age 2.38 years.
- Severe haemophilia A was most common (50%); all head injuries were mild.
- ICH occurred in 6/31 CT scans (19.4%), exclusively in symptomatic patients.
Conclusions:
- Intracranial hemorrhage is a significant risk after head trauma in haemophiliacs.
- CT scans are recommended for symptomatic patients and those with risk factors.
- Prolonged observation is advised for asymptomatic patients post-head trauma.
Introduction:
Haemophilia is one of the most common inherited bleeding disorders in the Emergency Department (ED). The most dangerous site of bleeding is the central nervous system.
Aims:
To describe the characteristics of haemophiliacs arrived to our ED following a head trauma and to analyse the incidence of intracranial haemorrhage (ICH).
Materials And Methods:
Retrospective, analytical, observational study, conducted in a Paediatric ED. We included haemophilic patients aged from birth to 16 years who consulted after a head trauma over a 6-year period. Data collected included age, type of haemophilia and head trauma, symptoms, prophylaxis status, CT imaging, treatment and number of visits to the ED.
Results:
About 46 males and 85 episodes were analysed. The median age was 2.38 years. Severe haemophilia A was the most frequent type of disease (50%). All head injuries were mild, and the most frequent mechanism was a collision with an object (38.8%). In 62 episodes (72.9%) the patients were asymptomatic. The rest 23 events had symptomatology, being the most common headache (26%), emesis (21.7%) and drowsiness (17.4%). Head CT was obtained in 31 episodes, founding altered results in 10 (6 of them corresponding to ICH). All the patients with ICH had symptomatology. About 37 episodes required admission.
Conclusion:
Intracranial haemorrhage is one of the most dangerous events in haemophiliacs and it may occur after a head trauma. Our study suggests that, in case of head trauma, CT must be obtained in symptomatic patients and in those with additional risk factors. Asymptomatic patients must have prolonged observation.
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