Head Trauma in Paediatric Patients Referring to a Spoke Hospital
DOI:
https://doi.org/10.12974/2311-8687.2024.12.01Keywords:
Computed tomography (CT) scan, Paediatric head trauma (HT), Traumatic head injury, First-level emergency department (ED)Abstract
Introduction: Head trauma (HT) is a leading cause of morbidity and mortality in children worldwide. The primary aim of this study was to describe patients presenting to our first-level Emergency Department (ED) following a HT. The secondary aims were to compare both the epidemiology and the management of paediatric patients with literature data, analyzing the appropriateness of management of children’s traumatic brain injuries according to the current guidelines.
Methods: We conducted a retrospective review of medical records of patients aged < 14 years who attended our first-level ED due to head trauma from July 1, 2021, and June 30, 2022. Clinical data, including age, gender, injury mechanism, location of trauma, time from traumatic event and ED arrival, symptoms at first evaluation, physical examination findings, radiological investigation results, medications administered in ED and prescribed at home, and outcome were collected and compared with data available in literature and current guidelines.
Results: A total of 117 children aged < 14 years who attended our first-level ED due to head trauma from July 1, 2021, and June 30, 2022, were analyzed. Most of them were males aged 1-3 years. Frontal bone was the commonest side of trauma (43% of HT). Only eleven patients (9%) had a brain CT scan and 4 of them showed pathological findings. None had signs of bleeding. Four of the patients were transferred to a HUB hospital, provided with a paediatric neurosurgery and more important none of them has developed neurological sequelae or death.
Discussion: Our 1-year observation of HT showed how this is a frequent indication for ED referral, especially in young children. In our hands less than 10% of cases required CT scan that reported pathological cases in 4 patients only (3%). We can conclude that the reduction of ionizing radiation exposition can be obtained with skilled experienced physicians.
References
Dewan MC, Mummareddy N, Wellons JC 3rd, Bonfield CM. Epidemiology of global pediatric traumatic brain injury: qualitative review. World Neurosurg. 2016; 91(497- 509): e1. https://doi.org/10.1016/j.wneu.2016.03.045
Araki T, Yokota H, Morita A. Pediatric Traumatic Brain Injury: Characteristic Features, Diagnosis, and Management. Neurol Med Chir (Tokyo). 2017 Feb; 57(2): 82- 93. https://doi.org/10.2176/nmc.ra.2016-0191
Fundarò C, Caldarelli M, Monaco S, Cota F, Giorgio V, Filoni S, et al. Brain CT scan for pediatric minor accidental head injury. An Italian experience and review of literature. Childs Nerv Syst. 2012 Jul; 28(7): 1063-8. https://doi.org/10.1007/s00381-012-1717-9
Schutzman SA, Greenes DS. Pediatric minor head trauma. Ann Emerg Med 2001; 37: 65-74. https://doi.org/10.1067/mem.2001.109440
Pinto PS, Poretti A, Meoded A, Tekes A, Huisman TA. The unique features of traumatic brain injury in children. Review of the characteristics of the pediatric skull and brain, mechanisms of trauma, patterns of injury, complications and their imaging findings-part 1. J Neuroimaging 2012; 22: e1-17. https://doi.org/10.1111/j.1552-6569.2011.00688.x
Ryan ME, Pruthi S, Desai NK, Falcone Jr RA, Glenn OA, Joseph MM, et al. ACR Appropriateness Criteria Head Trauma-Child. J Am Coll Radiol. 2020 May; 17(5S): S125-S137. https://doi.org/10.1016/j.jacr.2020.01.026
Abalo KD, Rage E, Leuraud K, Richardson DB, Ducou Le Pointe H, Laurier D, et al. Early life ionizing radiation exposure and cancer risks: systematic review and meta-analysis. Pediatr Radiol. 2021 Jan; 51(1): 45-56. https://doi.org/10.1007/s00247-020-04803-0
Stiell IG, Wells GA, Vandemheen K, Clement C, Lesiuk H, Laupacis A, et al. The Canadian CT Head Rule for patients with minor head injury. Lancet. 2001 May 5; 357(9266): 1391-6. https://doi.org/10.1016/S0140-6736(00)04561-X
Stein SC, Fabbri A, Servadei F, Glick HA. A critical comparison of clinical decision instruments for computed tomographic scanning in mild closed traumatic brain injury in adolescents and adults. Ann Emerg Med. 2009 Feb; 53(2): 180-8. https://doi.org/10.1016/j.annemergmed.2008.01.002
SIGN. Early management of patients with a head injury. A national clinical guideline. 2009. http: //www.sign.ac.uk/pdf/sign110.pdf.
Da Dalt L, Parri N, Amigoni A, Nocerino A, Selmin F, Manara R, et al. Italian guidelines on the assessment and management of pediatric head injury in the emergency department. Ital J Pediatr. 2018 Jan 15; 44(1): 7. https://doi.org/10.1186/s13052-017-0442-0
Gambacorta A, Moro M, Curatola A, Brancato F, Covino M, Chiaretti A, et al. PECARN Rule in diagnostic process of pediatric patients with minor head trauma in emergency department. Eur J Pediatr. 2022 May; 181(5): 2147-2154. https://doi.org/10.1007/s00431-022-04424-9
Kuppermann N, Holmes JF, Dayan PS, Hoyle JD Jr, Atabaki SM, Holubkov R, et al. Identification of children at very low risk of clinically-important brain injuries after head trauma: a prospective cohort study. Lancet. 2009; 374(9696): 1160- 70. https://doi.org/10.1016/S0140-6736(09)61558-0
Head injury: assessment and early management. National Institute for Health and Care Excellence: Clinical Guidelines. London 2019.
Taylor CA, Bell JM, Breiding MJ, Xu L. Traumatic brain injury-related emergency department visits, hospitalizations, and deaths-United States, 2007 and 2013. MMWR Surveill Summ. 2017; 66(9): 1- 16. https://doi.org/10.15585/mmwr.ss6609a1
McKinlay A, Grace RC, Horwood LJ, Fergusson DM, Ridder EM, MacFarlane MR. Prevalence of traumatic brain injury among children, adolescents and young adults: prospective evidence from a birth cohort. Brain Inj. 2008 Feb; 22(2): 175-81. https://doi.org/10.1080/02699050801888824
Giner J, Mesa Galán L, Yus Teruel S, Guallar Espallargas MC, Pérez López C, Isla Guerrero A et al. Traumatic brain injury in the new millennium: new population and new management. Neurologia (Engl Ed). 2022 Jun; 37(5): 383-389. https://doi.org/10.1016/j.nrleng.2019.03.024
Payne FL, Fernandez DN, Jenner L, Paul SP. Recognition and nursing management of abusive head trauma in children. Br J Nurs. 2017 Sep 28; 26(17): 974-981. https://doi.org/10.12968/bjon.2017.26.17.974
Mukhtar AA, Bergenfeldt H, Edelhamre M, Vedin T, Larsson P-A,Öberg S. The epidemiology of and management of pediatric patients with head trauma: a hospital-based study from Southern Sweden. Scand J Trauma Resusc Emerg Med. 2022 Dec 9; 30(1): 67. https://doi.org/10.1186/s13049-022-01055-9
Unden J, Dalziel SR, Borland ML, Phillips N, Kochar A, Lyttle MD, et al. External validation of the Scandinavian guidelines for management of minimal, mild and moderate head injuries in children. BMC Med. 2018; 16(1): 176. https://doi.org/10.1186/s12916-018-1166-8
Babl FE, Borland ML, Phillips N, Kochar A, Dalton S, McCaskill M, et al. Accuracy of Pecarn, Catch, and Chalice head injury decision rules in children: a prospective cohort study. Lancet. 2017; 389(10087): 2393-402. https://doi.org/10.1016/S0140-6736(17)30555-X