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Epidemiology of minor blunt head trauma in infants younger than 3 months
José Antonio Alonso-Cadenas1, Clara Ferrero García-Loygorri2, Rosa María Calderón Checa3
1Pediatric Emergency Department, Hospital Infantil Universitario Niño Jesús, Avenida de Menedez Pelayo 65, 28009, Madrid, Spain. jalonsoc@salud.madrid.org.
Insights
Minor head trauma in infants under 3 months is usually benign, with a low rate of clinically important traumatic brain injury. Prevention should focus on falls, and imaging strategies need optimization for this vulnerable population.
Area of Science:
- Pediatric Emergency Medicine
- Infant Trauma Research
- Neurotrauma Epidemiology
Background:
- Infants under 3 months are highly vulnerable to minor blunt head trauma.
- Subtle symptoms and minimal physical findings in infants complicate clinical assessment.
- Current guidelines recommend a low threshold for computed tomography (CT) scans in this age group.
Purpose of the Study:
- To describe the epidemiology of minor blunt head trauma in infants younger than 3 months presenting to pediatric emergency departments (PEDs).
- To inform preventive strategies and clinical management guidelines for infant head injuries.
Main Methods:
- Prospective study of infants (<3 months) with minor head trauma (Glasgow Coma Scale 14-15) across 13 Spanish PEDs (May 2017-Nov 2020).
- Data collected on trauma mechanisms, clinical presentation, physical examination findings, and imaging studies (CT, X-ray, ultrasound).
- Telephone follow-up conducted for 4 weeks post-visit.
Main Results:
- 369 infants met inclusion criteria; 56.3% were male.
- Falls accounted for 80.8% of trauma, primarily from furniture, strollers, or caregiver's arms.
- Most infants were asymptomatic (85.9%) with no injury signs on exam (56.9%).
- Clinically important traumatic brain injury (ciTBI) occurred in 0.3% of infants; TBI on CT in 3.3%; isolated skull fracture in 5.5%.
Conclusions:
- Minor head injuries in infants <3 months are generally benign with a low incidence of ciTBI.
- Prevention efforts should target falls from furniture, strollers, and caregivers.
- Optimizing diagnostic imaging, reducing unnecessary X-rays and CT scans, is crucial for this population.
Abstract:
Specific knowledge of the features of minor head trauma in infants is necessary to develop appropriate preventive strategies and adjust clinical management in pediatric emergency departments (PEDs). The aim of this study is to describe the epidemiology of minor blunt head trauma in infants < 3 months who present to PEDs. We performed a prospective study of infants evaluated in any of 13 Spanish PEDs within 24 h of a minor head trauma (Glasgow Coma Scale scores of 14-15) between May 2017 and November 2020. Telephone follow-up was conducted for all patients over the 4 weeks after the initial PED visit. Of 1,150,255 visits recorded, 21,981 children (1.9%) sustained a head injury, 386 of whom (0.03%) were under 3 months old. Among the 369 patients who met the inclusion criteria (0.03%), 206 (56.3%) were male. The main causes of trauma were fall-related (298; 80.8%), either from furniture (138/298; 46.3%), strollers (92/298; 30.9%), or a caregiver's arms (61/298; 20.5%). Most infants were asymptomatic (317; 85.9%) and showed no signs of injury on physical exam (210; 56.9%). Imaging studies were performed in 195 patients (52.8%): 37 (10.0%) underwent computed tomography (CT) scan, 162 (43.9%) X-ray, and 22 (6.0%) ultrasound. A clinically important traumatic brain injury (ciTBI) occurred in 1 infant (0.3% overall; 95% CI, 0-1.5), TBI was evidenced on CT scan in 12 (3.3% overall; 95% CI, 1.7-5.7), and 20 infants had an isolated skull fracture (5.5% overall; 95% CI, 3.4-8.3). All outcomes were caused by falls onto hard surfaces.
Conclusion:
Most head injuries in infants younger than 3 months are benign, and the rate of ciTBI is low. Prevention strategies should focus on falls onto hard surfaces from furniture, strollers, and caregivers' arms. Optimizing imaging studies should be a priority in this population.
What Is Known:
• Infants younger than 3 months are vulnerable to minor blunt head trauma due to their age and to difficulties in assessing the subtle symptoms and minimal physical findings detected on examination. • A low threshold for CT scan is recommended in this population.
What Is New:
• Most cases of blunt head trauma in infants younger than 3 months have good outcomes, and the rate of clinically important traumatic brain injury is low. • Optimizing imaging studies should be a priority in this population, avoiding X-ray examinations and reducing unnecessary CT scans.
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