Preschool children with head injury: comparing injury severity measures and clinical care (original) (raw)
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Outcome of head injury among paediatric patients in a tertiary care institute
2017
Background: Head injury in children accounts for a large number of emergency department visits and hospital admissions and is reported to be the leading cause of death and disability in children around the world. The Center for Disease Control (CDC) and Prevention and the National Center for Injury Prevention and Control label traumatic brain injury (TBI) a "silent epidemic." Objective: To study the outcome of head injury among paediatric patients reporting to a tertiary care institute. Materials and Method: All paediatric patients between ages one to 16 years, admitted with a history of head injury were included in the study. Children with underlying seizure disorder and with bleeding disorder were excluded from the study. Thus total 102 cases of head injury were enrolled in the present study. All patients were analyzed and classified according to their age, sex, pattern of injury, symptoms and examination findings at the time of presentation, CT Brain findings (if done),...
Spectrum of pediatric head injury with management and outcome – A single tertiary care centre study
The Indian Journal of Neurotrauma, 2015
Objective This study aims to conduct a survey on the pediatric head injury cases admitted to our hospital to identify the incidence, age, sex, mechanism and type of injury, other associated injuries, initial presentations, computed tomography finding, management, length of hospital stay, outcome in the form of condition at discharge, and outcome analysis using Glasgow outcome score (GOS). Methods This is a retrospective study of all children 18 years admitted for head injury to our hospital during the period August 2013 to June 2014. A total of 247 pediatrics head injury patients in between the age of 0 and 18 years were admitted and treated. In all cases age, sex, presenting symptoms, mechanism, type, severity, other associated injuries, management, duration of hospital stay, GOS, and so on, are analyzed from the stored pediatrics master register, computerized discharge tickets, patients profiles, admission register, death register, and bed head tickets. Results Of all the patients, there was a male preponderance (p < 0.001). The most common presenting feature was altered sensorium. The mean duration of hospitalization in our study is 4.0615 with 89.06% of patients staying < 7 days (p-value 0.001). Most common mechanism of head injury in children was found as road traffic accident (p < 0.001). Most common type of injury was extradural hematoma and about 62% intracranial pathology shows no skull fracture. Mortality rate is low as compared to all head trauma victims. Conclusion Outcome of pediatric head injury depends on initial presentation. Early recognition and prompt management contributes to decrease mortality and disability. Younger males are at a greater risk. Most injuries are mild-to-moderate in nature with high rate of good recovery.
Childhood head injury: causes, outcome, and outcome predictors
Pediatric Surgery International, 2004
Head injury is the most common cause of death following trauma among children in most developed and underdeveloped countries. Management of the head-injured child remained conservative in the hands of the general and orthopedic surgeons until October 2000 in our center. To determine outcome and outcome-predictors in children managed nonoperatively for head injury in Ilorin, Nigeria, a 10-year retrospective study of children managed for head injury was done. Outcome was measured by Glasgow outcome scoring. Clinical variables including age, gender, and postresuscitation Glasgow coma score were tested against Glasgow outcome score by linear regression analysis. During the study period (1989)(1990)(1991)(1992)(1993)(1994)(1995)(1996)(1997)(1998)(1999), 267 children (173 males and 94 females) aged 16 years and below with head injuries were admitted. Their injuries were due mostly to road traffic accidents (64.1%) and falls (30.7%). Other injuries were domestic, sport-related, or due to assaults or the fall of collapsed walls, water-pots, and coconut shells on victims' heads. Head injuries were isolated in 60% of patients but associated with skeletal, facial, and spinal injuries in 58, 18, and seven cases, respectively. They were mild in 100 (37.5%), moderate in 73 (27.3%), but severe in 94 (35.2%) cases. Outcome was good in 207 (77.5%) but fatal in 38 (14.2%) children. Only age (p=0.0206) and coma score (p=0.0000), but not gender (p= 0.3043), could predict outcome. Outcome was good in more than 75% of cases of head-injured children managed nonoperatively. It varied with the patient's age and postresuscitation Glasgow coma score.
European journal of medical research, 2015
In the current literature, the outcome of paediatric brain injury is controversially discussed. According to the majority of the studies, there seems to be a decreased mortality but worse recovery in paediatric, traumatic brain injury in comparison with adults. However, there is a lack of information concerning the differences in various stages of development in patients younger than 18 years. The aim of our study was to verify the in-hospital outcome of different paediatric age groups in comparison to adults with respect to the treatment strategy. We performed a retrospective analysis of the TraumaRegister DGU(®) from 2002 to 2012. Inclusion criteria were an Abbreviated Injury Scale (AIS) head ≥3 points and an AIS ≤2 points of the remaining body regions. The collective was divided into different subgroups according to age (1-3, 4-6, 7-10, 11-14, 15-17) and an adult control group aged between 18 and 55 years. We descriptively analysed the endpoint rate of sepsis, multiple organ fail...
Minimal head trauma in children revisited: Is routine hospitalization required?
Journal of Oral and Maxillofacial Surgery, 1998
Objective. Children with a question of occult head injury are routinely hospitalized despite having both normal central nervous system (CNS) and computed tomographic (CT) scan examinations. We determined the incidence of significant CNS morbidity after occult head injury to determine whether or not hospital admission was necessary in children after minimal head trauma. Methods. We reviewed the records of children admitted to a level I trauma center with a question of closed head injury, an initial Glasgow Coma Scale equal to 15, a normal neurologic exam, and a normal head CT scan. Children with associated injuries requiring admission were excluded. The endpoints were deterioration in CNS exam, new CT findings, and the need for a prolonged hospital stay. Results. Sixty-two patients were studied with a mean age of 7 years (range, 1 month to 15 years), and 65% were male. The primary mechanisms of injury were fall (45%) and vehicular crash (23%). The mean injury severity score was 4 ؎ 2. The mean length of stay was 1.2 days (range, 1 to 3 days). Prolonged hospitalization occurred in 9 patients (15%). No child developed significant CNS sequelae warranting hospital admission. Total charges for these hospitalizations were $177 874. Conclusions. Children undergoing emergency department work-up of occult head injury, who have a normal CNS exam and a normal head CT scan, do not seem to be at risk for significant CNS sequelae. These patients can be discharged home with parental supervision and avoid unnecessary and costly hospitalization.
Predictors of outcome in severely head-injured children
Critical Care Medicine, 2001
raumatic injuries account for 40% of deaths in U.S. children Ͼ1 yr of age (1), and head injury is the leading cause of traumatic death (2). Case fatality rates between 18% and 33% have been reported (3, 4). Serious head injury accounts for Ͼ30% of all admissions to a Pediatric Intensive Care Unit (PICU) (5).