Clinical Outcomes in Neurologically Intact Children With Small Intracranial Bleeds and Simple Skull Fractures

Area of Science:

• Pediatric Traumatology
• Neurocritical Care
• Emergency Medicine

Background:

• Hospitalization for minor head injuries in children is common, despite low rates of severe outcomes.
• Current monitoring practices may lead to unnecessary resource utilization.

Purpose of the Study:

• To determine the incidence of significant clinical sequela (SCS) in neurologically intact children with minor head trauma.
• To identify risk factors associated with SCS in this population.

Main Methods:

• Retrospective observational study of children aged ≤3 years admitted with closed head trauma.
• Inclusion criteria: intracranial hemorrhage (ICH) ≤5mm and/or simple skull fracture, Glasgow Coma Scale (GCS) ≥14.
• Data collected: demographics, resource use, outcomes; SCS defined as radiologic progression or clinical deterioration.

Main Results:

• 205 children enrolled; 6.3% experienced SCS.
• Radiologic progression occurred in 2.4% of patients.
• SCS was associated with male gender, child protective services involvement, and non-linear skull fractures.

Conclusions:

• Neurologically intact children with traumatic closed head injury have a low risk of SCS.
• Intensive care unit (ICU) monitoring may not be necessary for most of these children.
• Specific risk factors indicate a subset of children may benefit from closer observation.