[Pediatric cranio-encephalic trauma in the emergency ward]

A study was made of head injuries among children treated in hospital emergency services, along with an analysis of the corresponding health care pressures, type of treatment and possibilities of prevention.

A retrospective analysis was made of the last 152 pediatric head injuries seen in our center, with an evaluation of patient age, the cause and place of injury, and the individuals present at the time of the injury. When, where and what form of first aid was provided was also studied, along with the time elapsed before the arrival at the center, the reason for the consultation, severity of the injury and the treatment dispensed. The costs entailed are also evaluated.

During the study period, pediatric head injuries accounted for 5.25% of healthcare demands. A large majority of the injuries took place at home, in parks or at school (95.39%), in the presence of relatives or tutors, and with a male predominance of 2:1. In terms of age and sex distribution, two well differentiated groups were established, corresponding to ranges of 0-7 and 7-14 years. On the average, 30-40 minutes elapsed between the injury and arrival at the Emergency Room with most cases (80.27%) corresponding to minor injuries. Moderate head trauma accounted for 19.73% of the cases. Evaluation in the form of anamnesis and clinical exploration, with a 24 hour guided observation period, proved to be the most effective approach. Only 1.97% of the patients required cranial CAT exploration, with head X-rays proving to be ineffective and to generate unnecessary costs in all cases.

The management of pediatric head injuries should be returned to the charge of the primary healthcare areas. The adoption of such measure would improve prevention and treatment, while curbing costs. Cranial radiological exploration should be discarded as a complementary evaluation parameter. Within each particular healthcare area, common protocols should be established to facilitate the follow-up of these patients from the time of first arrival, including a 24 hour guided observation period even in the case of only slight head injuries.