Epidemiological and Clinico-radiological Evaluation of Head Injury in Pediatric Population
Mukesh Sharma1, Sharad Pandey2,3, Praveen Kumar1
1Department of NeuroSurgery, Sir Sunder Lal Hospital, IMS, BHU, Varanasi, Uttar Pradesh 221005, India.
Insights
Head injury in children is a leading cause of death. This study highlights road traffic accidents and falls as primary causes, emphasizing early intervention for better outcomes in pediatric traumatic brain injury (TBI).
Area of Science:
- Pediatric Traumatology
- Neuroscience
- Public Health
Background:
- Head injury is a significant cause of mortality in infants and children.
- Children under 15 represent a substantial portion of the population and head injury cases in India.
- Traumatic brain injury (TBI) necessitates analysis of epidemiological factors, management strategies, and outcomes.
Purpose of the Study:
- To identify the primary causes and distribution patterns of head injuries in pediatric populations.
- To analyze preventive measures for childhood head injuries.
- To evaluate management approaches for TBI, focusing on limiting primary injury and secondary insults.
Main Methods:
- Retrospective analysis of 497 pediatric patients (age <18) admitted with head injury.
- Categorization of injury modes, management strategies (conservative vs. surgical), and diagnostic findings.
- Assessment of patient outcomes using the Glasgow Outcome Score (GOS).
Main Results:
- Road traffic accidents (46.88%) and falls from height (34.8%) were the most frequent causes of TBI in children.
- Epidural hematoma and fracture hematoma were common CT findings.
- The majority of patients (344/497) were discharged with a GOS of 5, indicating good recovery, while 9 cases resulted in a persistent vegetative state (GOS-2).
Conclusions:
- Prompt intervention targeting the primary TBI lesion in children is associated with favorable outcomes.
- Effective management can mitigate secondary complications and improve recovery.
- Emphasizing self-care and safety gear is crucial for teenagers participating in TBI-prone activities.
Background:
Head injury in infancy and childhood has been documented as the single most common cause of death. In India, children aged <15 years constitute 35% of the total population and contribute to 20-30% of all head injuries. In this study, we attempted to analyze the epidemiological factors, management, and outcome of traumatic brain injury (TBI). The objective of this study were to find the causes of head injury in children and its pattern of distribution in this population and to analyze the efforts required to prevent the injury and management focusing on limiting the progression of primary brain injury and minimizing secondary brain insult.
Results:
A total of 2714 patients with head injury were admitted at our hospital during the study period and, out of them, 508 (18.17%) were pediatric patients with age less than 18 years. Of the 508 patients, only 497 patients were included in this study. In the present study, 357 (71.83%) were males and 140 (28.16%) were females. In total, 351 cases were managed conservatively whereas surgical intervention was conducted in 146 cases (P < 0.001). In this study, the most common mode of injury was a road traffic accident (RTA) (46.88%; n=233), followed by fall from height (34.8%; n=173) (P < 0.001). It was also seen that epidural hematoma and fracture hematoma were the most common computed tomography findings in pediatric patients with head injury followed by parenchymal contusion or contusion with or without fracture followed by diffuse axonal injury. A total of 344 cases out of 497 cases were discharged with Glasgow outcome score (GOS)-5 whereas nine cases remained in a persistent vegetative state (GOS-2).
Conclusion:
Early intervention aimed at the primary lesion in TBI in children generally carries a good outcome, and limits as much as possible the ongoing biomechanical, physiological, and pathological sequelae post-TBI. In teenagers, the importance of proper self-care along with adequate safety gears while doing any TBI-prone activity should be emphasized.
