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Mild Traumatic Brain Injury Characteristics and Symptoms in Preschool Children: How Do They Differ to School Age
Louise M Crowe1, Vanessa C Rausa2, Vicki Anderson1
1Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia; Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia; School of Psychological Sciences, University of Melbourne, Melbourne, Australia.
Insights
Preschool children with mild traumatic brain injury (TBI) show different symptoms and receive different care than older children. This highlights the need for age-specific TBI management strategies.
Area of Science:
- Pediatric Emergency Medicine
- Neurotrauma
- Child Neurology
Background:
- Mild traumatic brain injury (TBI) is common in children.
- Understanding age-specific differences in TBI presentation and management is crucial for optimal care.
Purpose of the Study:
- To compare injury causes, clinical presentation, and medical management of mild TBI between preschool-aged and school-aged children.
- To identify age-related disparities in the acute phase of mild TBI.
Main Methods:
- Secondary analysis of a large, prospective, multisite cohort study (Australian Paediatric Head Injury Rules Study).
- Comparison of 7080 preschool children (2-5 years) with 5251 school-age children (6-12 years) with mild TBI.
- Data collected via clinical report forms on symptoms, injury causes, and management.
Main Results:
- Preschoolers were less likely to be injured by projectiles (P<.001).
- Preschoolers presented with fewer symptoms like loss of consciousness, vomiting, drowsiness, and headache (P<.001), but more irritability/agitation (P=.003).
- Preschoolers were less likely to undergo neuroimaging (P<.001) or be admitted for observation (P<.001).
Conclusions:
- Preschool children exhibit a distinct acute symptom profile following mild TBI compared to older children.
- These differences have significant implications for medical management, including decisions on neuroimaging and post-acute interventions.
- Age-specific approaches are essential for effective TBI care in pediatric populations.
Objective:
To investigate if preschool children differ to school age children with mild traumatic brain injury (TBI) with respect to injury causes, clinical presentation, and medical management.
Design:
A secondary analysis of a dataset from a large, prospective and multisite cohort study on TBI in children aged 0-18 years, the Australian Paediatric Head Injury Rules Study.
Setting:
Nine pediatric emergency departments (ED) and 1 combined adult and pediatric ED located across Australia and New Zealand.
Participants:
7080 preschool aged children (2-5 years) were compared with 5251 school-age children (6-12 years) with mild TBI (N= (N=12,331) MAIN OUTCOME MEASURES: Clinical report form on medical symptoms, injury causes, and management.
Results:
Preschool children were less likely to be injured with a projectile than school age children (P<.001). Preschool children presented with less: loss of consciousness (P<.001), vomiting (P<.001), drowsiness (P=.002), and headache (P<.001), and more irritability and agitation (P=.003), than school-age children in the acute period after mild TBI. Preschool children were less likely to have neuroimaging of any kind (P<.001) or to be admitted for observation than school age children (P<.001).
Conclusions:
Our large prospective study has demonstrated that preschool children with mild TBI experience a different acute symptom profile to older children. There are significant clinical implications with symptoms post-TBI used in medical management to aid decisions on neuroimaging and post-acute intervention.
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