Characteristics of Minor Head Trauma in Toddlers

Objective: The objective of present study is to evaluate mechanisms and causes of head trauma, factors influencing management of pediatric minor head trauma, to highlight decision making processes in diagnostic imaging as well as searching for preventive measures for head trauma. Methods: Children younger than two years of age who were admitted to emergency department in one-year study period due to minor head trauma were included to the study. Results: To be inside or outside of house did not significantly change the incidence of falls for children younger than 2 years of age(p=0,096). Incidence of falls was significantly increased at living rooms(p=0.01) and bathrooms(p=0,036). Incidence of scalp hematomas was significantly higher in symptomatic patients(p=0,006). Asymptomatic admission after a minor injury was not a significant factor on decision of diagnostic imaging. Conclusions: A patient’s asymptomatic presentation should not be used as a criterion to rule out cerebral injuries. A lack of obvious signs and symptoms during evaluation does not exclude TBI. Existing serious symptoms should lead to a quick evaluation of patient to rule out a possible surgical emergency. Scalp hematomas are significantly associated with cerebral injury and are a predictor of brain injury. Clinicians should have a lower threshold for imaging in children

___

  • 1. Hawley C, Wilson J, Hickson C, Mills S, Ekeocha S, Sakr M. Epidemiology of paediatric minor head injury: Comparison of injury characteristics with indices of multiple deprivation. Injury 2013; 44: 1855-61.
  • 2. Hardelid P, Davey J, Dattani N, Gilbert R. Child deaths due to injury in the four UK countries: A time trends study from 1980 to 2010. PloS one 2013; 8: e68323.
  • 3. Schutzman SA, Barnes P, Duhaime AC, Greenes D, Homer C, Jaffe D, et al. Evaluation and management of children younger than two years old with apparently minor head trauma: proposed guidelines. Pediatrics 2001; 107: 983-93.
  • 4. Gordy C, Kuns B. Pediatric Abusive Head Trauma. Nurs Clin 2013; 48: 193–201. 5. Crowe L, Anderson V, Babl FE. Application of the CHALICE clinical prediction rule for intracranial injury in children outside the UK: impact on head CT rate. Arch Dis Child 2010; 95:1017-22.
  • 6. 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; 374:1160-70.
  • 7. Maxwell WL. Traumatic brain injury in the neonate, child and adolescent human:An overview of pathology. Int. J. Devl Neuroscience 2012; 30: 167–83.
  • 8. Siddiqui E, Ejaz K, Siddiqui U. Unintentional, paediatric domestic injury in a semi rural area of Karachi. J Pak Med Assoc 2012; 62: 638-43.
  • 9. Deans KJ, Thackeray J, Askegard-Giesmann JR, Earley E, Groner JI, Minneci PC. Mortality increases with recurrent episodes of nonaccidental trauma in children. J Trauma Acute Care Surg 2013; 75: 161-5.
  • 10. Mannix R, Meehan WP, Monuteaux MC, Bachur. RG. Computed tomography for minor head injury: variation and trends in major United States pediatric emergency departments. J Pediatr 2012; 160: 136-9.
  • 11. Paule Anthikkat A, Page A, Barker R. Risk factors associated with injury and mortality from paediatric low speed vehicle incidents: a systematic review. Int J Pediatr 2013; 2013.
  • 12. Pickering A, Harnan S, Fitzgerald P, Pandor A, Goodacre S. Clinical decision rules for children with minör head injury: a systematic review. Arch Dis Child 2011; 96: 414-21.
  • 13. Hamilton M, Mrazik M, Johnson DW. Incidence of delayed intracranial hemorrhage in children after uncomplicated minör head injuries. Pediatrics 2010; 126: e33-9.
  • 14. Holmes JF, Borgialli DA, Nadel FM, Quayle KS, Schambam N, Cooper A, et al. Do children with blunt head trauma and normal cranial computed tomography scan results require hospitalization for neurologic observation? Ann Emerg Med 2011; 58: 315-22.
  • 15. Höllwarth ME. Prevention of unintentional injuries: a global role for pediatricians. Pediatrics 2013; 132: 4-7.