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Mode, presentation, CT findings and outcome of pediatric head injury
1Department of Pediatrics, Command Hospital (Western Command), Chandimandir.
Insights
Pediatric head injuries are common. Most children with head trauma can be safely managed non-surgically with a multidisciplinary approach and CT availability, showing good recovery rates.
Area of Science:
- Pediatric Traumatology
- Neurosurgery
- Emergency Medicine
Background:
- Head injuries represent a significant cause of pediatric hospital admissions.
- Pediatric head injuries present unique clinical and management challenges compared to adults.
Purpose of the Study:
- To compare head injury management and outcomes in children under 10 versus older patients.
- To evaluate the necessity of neurosurgical intervention for pediatric head injuries.
Main Methods:
- Retrospective analysis of 312 head injury patients at Command Hospital (WC), Chandimandir.
- Comparison of injury mechanisms, presentation, CT findings, and outcomes between pediatric and adult groups.
- Assessment of management protocols including CT scans and neurosurgical consultations.
Main Results:
- Children (27.8%) predominantly sustained injuries from falls; common symptoms included vomiting and drowsiness.
- Cerebral edema was the primary CT finding in 74% of pediatric cases; only 4.6% required neurosurgical transfer.
- Pediatric mortality was lower (5.7%) than in older patients (11.6%), with 80.5% recovering without deficits.
Conclusions:
- A multidisciplinary approach and CT availability allow safe management of most pediatric head injuries in general surgical units.
- Neurosurgical intervention is infrequently required for pediatric head trauma, suggesting conservative management is often appropriate.
- Children exhibit favorable recovery outcomes from head injuries, underscoring the importance of specialized pediatric care protocols.
Abstract:
Twenty five to thirty per cent of all patients admitted with head injuries to any large hospital are children. Head injuries in children differ in several ways from those seen in the adult population. A standard management protocol is used in a service hospital and CT and neurosurgical consultation/transfer is based on specific criteria. The records of 312 patients admitted with head injury to Command Hospital (WC), Chandimandir were retrospectively analysed to compare the mode of injury, initial presentation, CT findings and the outcome of management between those above and those below the age of 10 years. Eighty seven (27.8%) of the 312 patients were children and 71% of them had sustained the injury due to fall from a height. One third of children were brought with vomiting and drowsiness and 9.2% with seizures, but lateralizing signs were found in only 5.7%. Nineteen children underwent a CT of the head and of these 74% had only cerebral edema. Only 4 of the 87 children were transferred to a neurosurgical unit. The mortality rate was lower in children (5.7%) compared to the older age group (11.6%) but the difference was not statistically significant. However, a significantly higher number (80.5%) of children recovered without any residual deficit. Majority of our children can be safely managed in a general surgical unit provided a multidisciplinary approach is used and facilities of CT are readily available, since very few require active neurosurgical intervention.