[Pediatric head injury: evaluation of the new institutional protocol]
Balázs Fadgyas1, Péter Altorjai2, Dorottya Őri3,4
11 Heim Pál Országos Gyermekgyógyászati Intézet, II. Gyermeksebészeti Osztály Budapest, Üllői út 86., 1089 Magyarország.
Insights
Hungary revised its pediatric head injury protocol, reducing routine skull X-rays and emphasizing clinical assessment. This change led to more admissions for observation but fewer X-rays in children with mild head injuries.
Area of Science:
- Pediatric Traumatology
- Clinical Protocol Development
- Medical Imaging in Pediatrics
Background:
- Local Hungarian practice for pediatric minor head injuries varied, often involving routine skull X-rays.
- This routine contrasted with international guidelines for managing pediatric head trauma.
Purpose of the Study:
- To evaluate the impact of a new institutional protocol for minor head injuries in children, implemented in 2020.
- To compare care practices and outcomes before and after the protocol change.
Main Methods:
- A retrospective observational cohort study at the Heim Pál National Institute of Pediatrics (2018-2022).
- Compared two groups: pre-protocol (2018-2019) and post-protocol (2021-2022) for children aged 0-18 with mild head injuries.
- Analyzed skull X-ray rates, admissions, and observation durations using chi-square tests.
Main Results:
- The number of skull X-rays significantly decreased post-protocol (88.63% to 23.83%, p<0.0001).
- Patient admissions increased significantly (17.92% to 34.11%, p<0.0001), with shorter observation periods (6-24 hours vs. 48 hours).
Conclusions:
- The 2020 protocol successfully reduced routine skull X-ray use in pediatric mild head injuries.
- The protocol shifted focus to clinical observation and physical examination, optimizing resource utilization.
Introduction:
In Hungary, minor head injuries in children are treated by representatives of several professions according to local practice. Skull X-rays were often routinely performed, in contrast to international practice.
Objective:
To examine the previous and the current institutional minor head injury care protocol introduced in 2020.
Method:
A retrospective, observational cohort study was conducted between 2018 and 2022 at the Heim Pál National Institute of Pediatrics. Before 2020, all children with head injuries were treated at the pediatric trauma outpatient clinic, and a skull X-ray was routinely performed. The protocol introduced in 2020 no longer required this for minor head injuries. Patients were divided into two groups: group A for those treated in 2018-2019 and group B for those treated in 2021-2022. Inclusion criteria were age 0-18 years, isolated, mild head injury. The number of X-ray examinations performed, outpatients or patients admitted to the ward were registered. The chi-square test was used for statistical analysis.
Results:
17.92% (n = 1886) of children in group A were admitted to the ward, while 34.11% (n = 2353) in group B were admitted (p<0.0001). 10 520 patients in group A were treated for mild head injury, while 6898 patients in group B were treated. The number of X-rays performed in connection with all head injuries decreased in group B (1644/6898, 23.83%) compared to group A (9324/10 520, 88.63%) (p<0.0001).
Discussion:
The new protocol emphasizes observation and physical examination and does not recommend routine skull X-rays. Most patients with mild head injuries are now treated in the Emergency Department, while those with more severe symptoms or co-injuries are treated in the Traumatology Department.
Conclusion:
After the introduction of the new protocol, more patients were admitted, but for shorter periods of observation than before (6-24 hours instead of 48). Orv Hetil. 2026; 167(23): 916-922.
