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Published on: October 17, 2017
Pediatric head injuries: particularities and neurosurgical experience in a lower-middle income country
Amine Trifa1, Mouna Rkhami2, Kais Maamri3
1Neurosurgery Department, Fattouma Bourguiba Hospital, Rue Farhat Hached, Monastir, 5000, Tunisia. trifa_amine@hotmail.com.
Insights
This study analyzed pediatric neurosurgical management of cranial trauma in Tunisia. Most children experienced favorable outcomes after surgery for head injuries, with age and injury severity being key prognostic factors.
Area of Science:
- Neurosurgery
- Pediatric Traumatology
- Epidemiology
Background:
- Pediatric head trauma presents unique challenges in neurosurgical management.
- Understanding the specific epidemiological and clinical features of child cranial trauma is crucial for effective treatment.
- Limited data exists on the neurosurgical management of pediatric head injuries in Tunisia.
Purpose of the Study:
- To identify the causes and epidemiological characteristics of pediatric head injuries in Tunisia.
- To explore the clinical specificities and neurosurgical management of child cranial trauma.
- To analyze the short- and long-term postoperative outcomes in pediatric patients.
Main Methods:
- A retrospective review of 118 children with head injuries undergoing surgery over five years.
- Data collection included demographics, clinical presentation, neuroimaging, surgical procedures, complications, and outcomes.
- Analysis focused on identifying causes, clinical features, and prognostic factors.
Main Results:
- An annual incidence of 24 pediatric neurosurgical cases was observed.
- Falls were the leading cause, followed by road traffic accidents.
- Loss of consciousness was the most common initial symptom; epidural hematoma evacuation was the most frequent surgery. 88% had favorable outcomes at 24 months.
Conclusions:
- Age, accident circumstances, polytrauma, Glasgow Coma Scale, lesion nature, and management timeliness significantly impact prognosis.
- Effective neurosurgical management leads to favorable outcomes in the majority of pediatric head trauma cases.
- This study provides essential data for improving pediatric neurosurgical care in Tunisia.
Purpose:
To the best of our knowledge, this is the first study conducted in Tunisia on the neurosurgical management of child cranial trauma. The objectives of the present work were to identify the causes of pediatric head injuries, explore epidemiological and clinical specificities, and analyze the short- and long-term postoperative evolution.
Methods:
A retrospective review was conducted on one hundred children with head injuries over a five-year period at one of the largest neurosurgery departments in Tunisia. The collected data encompassed demographic information, clinical presentation features, neuroimaging characteristics, surgical management, complications, and outcomes.
Results:
Over a five-year period, we have found 118 children who have undergone surgery, representing an annual incidence of twenty-four children per year. The average age was 10 years. Falls emerged as the primary cause of childhood head injuries in our series, followed by road traffic accidents. The most frequently encountered initial sign was the loss of consciousness (52%), followed by headaches (28%), vomiting (25%), and seizures (8%). The average time between the accident and admission to the operating unit was 10 h. Various neurosurgeries were performed, with the evacuation of an epidural hematoma being the most common procedure. At a median follow-up of 24 months, the outcomes were favorable in 88% of cases.
Conclusion:
The main prognostic factors for head trauma in children included age, circumstances of the accident, association with polytrauma, the initial Glasgow Coma Scale, the nature of the initial cerebral lesions, and the timeliness and quality of initial management.
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