Paediatric head trauma: influence of age and sex. I. Epidemiology

Incidence, and factors associated with moderate/severe pediatric traumatic brain injury in children aged 5-15 years in western, Mexico

OBJECTIVE

The study objectives were to estimate the standardized incidence and evaluate factors associated with moderate/severe pediatric traumatic brain injury (p-TBI) in children aged 5-15 years in Western, Mexico.

METHODS

The study was cross-sectional in design. We estimated the standardized incidence of moderate/severe p-TBI using the direct methods of the World Health Organization (WHO) standard populations. We utilized the Glasgow Coma Scale (GCS) to identify moderate/severe p-TBI patients (GCS ≤ 13). Logistic regression analysis was applied to evaluate variables associated with moderate/severe p-TBI.

RESULTS

The standardized incidence of patients diagnosed with moderate/severe p-TBI was 31.0/100,000 person-years (95 % CI 28.7-33.4). According to age, the moderate/severe TBI group was included. A total of 254 (38.5 %) patients were aged 5-9 years, 343 (52.0 %) were aged 10-14 years, and 62 (9.5 %) were aged 15 years. Factors associated with moderate/severe TBI in the crude analysis were male sex (OR 5.50, 95 % CI 4.16-7.39, p < 0.001), primary school (OR 2.15, 95 % CI 1.62-2.84, p < 0.001), and falls (OR 1.34, 95 % CI 1.02-1.77, p = 0.035). Factors associated with moderate/severe p-TBI in the adjusted analysis were male sex (OR 6.12, 95 % CI 4.53-8.29, p < 0.001), primary school (OR 3.25, 95 % CI 2.31-4.55, p < 0.001), and falls (OR 1.78, 95 % CI 1.28-2.47, p < 0.001).

CONCLUSION

The incidence of moderate/severe p-TBI in children aged 5-15 years in western Mexico in this study was higher than that in other studies. One of the biggest factors associated with moderate/severe p-TBI was male sex, specifically those with lower education levels and those who were prone to falls.

Underreporting of Traumatic Brain Injuries in Pediatric Craniomaxillofacial Trauma: A 20-Year Retrospective Cohort Study

BACKGROUND

Despite clinical concerns associated with pediatric traumatic brain injuries (TBIs), they remain grossly underreported. This is the first retrospective study to characterize concomitant pediatric TBIs and craniomaxillofacial (CMF) trauma patients, including frequency, presentation, documentation, and outcomes.

METHODS

An institutional review board-approved retrospective cohort study was performed to identify all pediatric patients presenting with CMF fractures at a high-volume, tertiary trauma center between the years 1990 and 2010. Patient charts were reviewed for demographic information, presentation, operative management, length of stay, mortality at 2 years, dentition, CMF fracture patterns, and concomitant TBIs. Data were analyzed using two-tailed t tests and chi-square analysis. A value of P≤ 0.05 was considered statistically significant.

RESULTS

Of the 2966 pediatric CMF trauma patients identified and included for analysis [mean age, 7 ± 4.7 years; predominantly White (59.8%), and predominantly male (64.0%)], 809 had concomitant TBI (frequency, 27.3%). Only 1.6% of the TBI cases were documented in charts. Mortality at 2 years, length of stay in the hospital, and time to follow-up increased significantly from mild to severe TBIs. Concomitant TBIs were more common with skull and upper third fractures than CMF trauma without TBIs (81.8% versus 61.1%; P < 0.05).

CONCLUSIONS

Concomitant TBIs were present in a significant number of pediatric CMF trauma cases but were not documented for most cases. CMF surgeons should survey all pediatric CMF trauma patients for TBI and manage with neurology and/or neurosurgery teams. Future prospective studies are necessary to characterize and generate practice-guiding recommendations.

CLINICAL QUESTION/LEVEL OF EVIDENCE

Risk, II.

Game-related injuries in schools: a retrospective nationwide 6-year evaluation and implications for prevention policy

Background

Child injury is a global public health problem. Children spend 25–50% of their daytime in school and risks of school accidents are high. The purpose of this study is to perform a comprehensive analysis of game-related injuries.

Methods

A nationwide dataset of 36,002 school injury events that occurred in Israel between 2013 and 2019 and were served by the National EMS, was used. The relations between different variables were demonstrated using multidimensional frequency tables. Z-tests, chi-square tests, ANOVA tests, and J48 classification trees were used to analyze the data.

Results

The prevailing injury cause (36.8%) was “game”, 44.8% of which occur during breaks, and the most frequently injured body regions were head, hand, and leg/foot (47.2%, 26.7%, and 19.7%, respectively). Age was negatively correlated with head injuries and positively correlated with limb injuries. 33% of all injuries occur in the playground and 20.1% occur in the sports field. About 33.3% of game-related injuries in elementary schools occur during the 10:00 a.m. break and an additional 24.7% during the 12:00 p.m. lunch break.

Conclusion

Games are the prevailing cause of school injuries in Israel. Gender and age differences, and seasonal and circadian trends were observed. Understanding the patterns and the trends of school injuries can enable the development of effective prevention policies on the national, municipal, and local levels, focusing the efforts on the key factors affecting injury incidence. Efficient use of resources is necessary, taking into account resource and budget constraints. Efforts can include education of teachers and pupils in relation to school accidents, promoting a safer physical environment, safety education, staff development and family and community involvement, and coordinative training with a focus on proprioception.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13584-021-00487-5.

Epidemiology of Traumatic Brain Injury in Europe: A Living Systematic Review

This systematic review provides a comprehensive, up-to-date summary of traumatic brain injury (TBI) epidemiology in Europe, describing incidence, mortality, age, and sex distribution, plus severity, mechanism of injury, and time trends. PubMed, CINAHL, EMBASE, and Web of Science were searched in January 2015 for observational, descriptive, English language studies reporting incidence, mortality, or case fatality of TBI in Europe. There were no limitations according to date, age, or TBI severity. Methodological quality was assessed using the Methodological Evaluation of Observational Research checklist. Data were presented narratively. Sixty-six studies were included in the review. Country-level data were provided in 22 studies, regional population or treatment center catchment area data were reported by 44 studies. Crude incidence rates varied widely. For all ages and TBI severities, crude incidence rates ranged from 47.3 per 100,000, to 694 per 100,000 population per year (country-level studies) and 83.3 per 100,000, to 849 per 100,000 population per year (regional-level studies). Crude mortality rates ranged from 9 to 28.10 per 100,000 population per year (country-level studies), and 3.3 to 24.4 per 100,000 population per year (regional-level studies.) The most common mechanisms of injury were traffic accidents and falls. Over time, the contribution of traffic accidents to total TBI events may be reducing. Case ascertainment and definitions of TBI are variable. Improved standardization would enable more accurate comparisons.

Sex differences in pediatric traumatic brain injury

The response of the developing brain to traumatic injury is different from the response of the mature, adult brain. There are critical developmental trajectories in the young brain, whereby injury can lead to long term functional abnormalities. Emerging preclinical and clinical literature supports the presence of significant sex differences in both the response to and the recovery from pediatric traumatic brain injury (TBI). These sex differences are seen at all pediatric ages, including neonates/infants, pre-pubertal children, and adolescents. As importantly, the response to neuroprotective therapies or treatments can differ between male and females subjects. These sex differences can result from several biologic origins, and may manifest differently during the various phases of brain and body development. Recognizing and understanding these potential sex differences is crucial, and should be considered in both preclinical and clinical studies of pediatric TBI.

Follow-Up Computed Tomography Requirement of Pediatric Head Trauma Patients with Abnormal Imaging Findings

OBJECTIVE

We investigated pediatric patients presenting with isolated head trauma to emergency service. Where abnormal findings were detected on brain computed tomography (CT) scan, we evaluated the follow-up scan rate and whether follow-up scans affected the treatment protocol.

METHODS

Pediatric patients who presented to emergency service between 2014 and 2017 with isolated head trauma and were later found to have abnormal findings on CT scan were evaluated. The patients were evaluated in terms of age, sex, pediatric Glasgow Coma Scale score at emergency service, trauma mechanism, and abnormal findings on CT scan. We also documented whether follow-up CT scan altered the treatment decision in patients as to whether they underwent surgery or received conservative treatment.

RESULTS

The 105 head trauma patients with abnormal findings on CT scan consisted of 58 boys (55.2%) and 47 girls (44.8%). After the first brain CT examination, 5 of the patients (4.7%) underwent emergency surgery. For patients with linear fractures, the number of follow-up CT scans was 2.3. For patients with linear fractures, vomiting was found to be a symptom with statistical meaning as a sign of additional cranial pathology compared with headache, drowsiness, and irritability. A total of 280 follow-up CT scans with a mean number of 2.66 per patient were performed.

CONCLUSIONS

Follow-up CT scan for patients with abnormal findings on the initial CT scan after head trauma does not influence the decision to choose clinical observation or surgery except in patients with neurologic deterioration.

Prediction of Poor Prognosis After Severe Head Injury in Children Using Logistic Regression

OBJECTIVES

Head trauma is one of the main causes of death in childhood and often leaves severe disability with serious neurological damage. Appropriate treatment must be provided immediately to improve outcomes. This study was performed to identify factors associated with a poor prognosis at an early stage of severe head injury in children.

METHODS

The subjects were registered in the Japan Neurotrauma Data Bank. They were 119 children (mean age, 8 years; male, 67.2%) with severe head injury registered during a period of 4 years (from July 1, 2004 to June 30, 2006 and from July 1, 2009 to June 30, 2011). Univariate and multivariate analyses were performed to examine relationships among factors and outcome 6 months after discharge. Logistic regression analysis was performed to develop models for poor prognosis and death.

RESULTS

Outcome was evaluated based on the Glasgow Outcome Scale: 73 children (61.3%) had good recovery, 11 (9.2%) had moderate disability, 8 (6.7%) had severe disability, 4 (3.3%) were in a vegetative state, and 23 (19.3%) had died. Four factors were identified as predictors of a poor prognosis: serum glucose level greater than or equal to 200 mg/dL, Glasgow Coma Scale score on admission less than or equal to 5, presence of mydriasis, and presence of traumatic subarachnoid hemorrhage. Three factors were identified as predictors of death: serum glucose level greater than or equal to 200 mg/dL, Glasgow Coma Scale score on admission less than or equal to 5, and presence of mydriasis.

CONCLUSIONS

Using these predictors, subsequent exacerbation may be predicted just after arrival at the hospital and appropriate treatment can be provided immediately.

Mortality and Epidemiology in 256 Cases of Pediatric Traumatic Brain Injury: Korean Neuro-Trauma Data Bank System (KNTDBS) 2010-2014

Objective

Among pediatric injury, brain injury is a leading cause of death and disability. To improve outcomes, many developed countries built neurotrauma databank (NTDB) system but there was not established nationwide coverage NTDB until 2009 and there have been few studies on pediatric traumatic head injury (THI) patients in Korea. Therefore, we analyzed epidemiology and outcome from the big data of pediatric THI.

Methods

We collected data on pediatric patients from 23 university hospitals including 9 regional trauma centers from 2010 to 2014 and analyzed their clinical factors (sex, age, initial Glasgow coma scale, cause and mechanism of head injury, presence of surgery).

Results

Among all the 2617 THI patients, total number of pediatric patients was 256. The average age of the subjects was 9.07 (standard deviation±6.3) years old. The male-to female ratio was 1.87 to 1 and male dominance increases with age. The most common cause for trauma were falls and traffic accidents. Age (p=0.007), surgery (p<0.001), mechanism of trauma (p=0.016), subdural hemorrhage (SDH) (p<0.001), diffuse axonal injury (DAI) (p<0.001) were statistically significant associated with severe brain injury.

Conclusion

Falls were the most common cause of trauma, and age, surgery, mechanism of trauma, SDH, DAI increased with injury severity. There is a critical need for effective fall and traffic accidents prevention strategies for children, and we should give attention to these predicting factors for more effective care.

Traumatic nondisplaced coronal suture fracture causing delayed intracranial hemorrhage in a pediatric patient

Skull fracture after a head injury is relatively common in children younger than 2 years of age. The author reports the case of a 14-month-old girl who sustained a unilateral nondisplaced coronal suture fracture from a fall. She developed delayed intracranial hemorrhage from an underlying dural tear and cortical vein injury. Although an isolated skull fracture in a pediatric trauma patient typically portends a benign clinical course and may not require that the patient be hospitalized, a nondisplaced fracture across the coronal suture can lead to dural tear and intracranial injuries. High vigilance is warranted when evaluating CT images around the suture lines and treating pediatric patients with fractures across the coronal suture.

Preinjury characteristics of children with mild traumatic brain injury: Is "other injury" an appropriate comparison group"?

BACKGROUND

Mild traumatic brain injury (mTBI) has been associated with ongoing problems in children and young people. However, there remains to be considerable debate regarding whether outcomes are a result of brain impairment, or simply reflect preinjury characteristics of the child or family. To reliably assess outcomes, an appropriate control group is required.

AIMS

This study aimed to identify the preinjury characteristics of children with mTBI, and to examine whether an "other injury to the head" group is an appropriate comparison to control for preinjury characteristics of children with mTBI.

METHOD

Parents of 290 children admitted to the emergency department with either a diagnosis of mTBI (n = 186, M = 6.44 years) or a superficial injury to the head (SIH) (n = 104, M = 5.40 years) were assessed. Parents completed three questionnaires examining behavioral problems (Clinical Assessment of Behavior), parental stress (Parenting Stress Index), and background variables (e.g., medical issues, socioeconomic factors).

RESULTS

A series of chi-square analyses and multivariate analysis of variance tests revealed no differences for behavior, parental stress, and other preexisting problems between children with mTBI and those with SIH.

CONCLUSIONS

Children who experience a mTBI event present similarly to individuals with a SIH, and SIH is an appropriate comparison group to examine the outcomes of childhood mTBI, as it may help minimize any confounding effects of preexisting issues associated with mTBI.

The role of decompressive craniectomy in children with severe traumatic brain injury

OBJECTIVE

Severe traumatic brain injury (TBI) remains the leading cause of death in children. The present study analyses the outcome of children after severe TBI treated by decompressive craniectomy (DC) due to elevated intracranial pressure (ICP) in a single centre.

METHODS

Fifty-six consecutive children (age < 16 years) were treated for severe TBI at our institution between 2001 and 2011. For study purposes, children with severe generalized traumatic brain swelling without concomitant mass lesion were further analysed. Descriptive statistics were used to report clinical conditions as well as outcome measurements after conservative treatment only in comparison to secondary decompressive craniectomy.

RESULTS

Of 56 children, a total of eight children presented with generalized and progressive traumatic brain swelling and impending brain herniation. Four children were treated conservatively following standardized local protocol for anti-oedematous management, with ICP amenable to intensified therapy. Four children required decompressive surgery due to progressive oedema refractory to intensified conservative management. Children receiving secondary DC had a longer stay in the intensive care unit as well as a longer average time of assisted ventilation compared to children treated conservatively. Concomitant injuries were more severe in the DC subgroup. Yet, Glasgow Outcome Scale was equally distributed in both groups.

CONCLUSION

In children with refractory ICP conditions due to severe TBI, decompressive surgery might lead to a similar favourable outcome compared to children in whom ICP can be controlled only by conservative management. Timing of surgery depends on the neurological deterioration of the patients and a continuous ICP monitoring.

Epidemiology of traumatic head injury in Korean children

The aim of this study was to elucidate the epidemiology of traumatic head injury (THI) among Korean children. A prospective, in-depth trauma survey was conducted in five teaching hospitals. Data from all of the children who attended the emergency department (ED) were analyzed. From June 2008 to May 2009, 2,856 children with THI visited the 5 EDs. The average age of the subjects was 5.6 (SD ± 4.9) yr old, and 1,585 (55.5%) were 0-4 yr old. The male-to-female ratio was 2.3 to 1 (1,979 vs 877). Consciousness levels of the subjects were classified according to the Glasgow Coma Scale (GCS), and 99.1%, 0.6%, and 0.4% were determined as mild, moderate, or severe injury, respectively, according to the GCS categorization. Most injuries occurred at home (51.3%), and the most common mechanism of injury was collision (43.2%). With regard to outcome, 2,682 (93.9%) patients were sent home, and 35 (1.2%) were transferred to another hospital. A total of 133 (4.7%) patients were hospitalized, and 38 (1.3%) underwent surgery. The incidence and characteristics of pediatric THI in Korea are affected by sex, location and injury mechanism.

The pediatric athlete: younger athletes with sport-related concussion

Although much of the lay media attention surrounding sport-related concussion (SRC) focuses on professional athletes, SRC is a common injury in pediatric sports. The anatomy, biomechanics, and response to injury of the developing pediatric brain differ from those of the adult. Similarly, the neurocognitive abilities of the child are developing more rapidly than in an adult. The effects of concussive brain injury on the life of a child are different from those of an adult. This article focuses on the aspects of SRC that are specific to the younger athletes.

Outcome of head trauma

OBJECTIVE

To investigate the outcome of head trauma and its related factors in Iranian children.

METHODS

In a nonrandomized cross-sectional study 380 patients younger than 18-yr-old admitted to the surgery ward of Ali-E-Bne-Abitaleb Hospital, Rafsanjan due to head trauma were included. In all of them, skull X-ray and brain CT scan were performed under the supervision of the neurologist and neurosurgeon according to special indications. Patients were followed till discharge from the hospital or death. At the time of discharge, the patients were evaluated by pediatrician. Demographic information and imaging findings were statistically analyzed using SPSS software.

RESULTS

Male to female ratio was 3:1 Most cases were in the age range of 7-12 year. Seventy two percent and 11% of patients' admission was due to motor accidents and falling, respectively. Eighty two percent of patients were discharged with complete recovery; also 12% of skull-radiographs and 17% of brain CT scans were abnormal.

CONCLUSION

Head trauma had more prevalence and mortality in male than female. Also in the present study, motor accidents as an etiology of head trauma was more frequent than the western countries, which demands special precautions to decrease this problem.

Amantadine treatment following traumatic brain injury in children

PRIMARY OBJECTIVE

The focus of this paper is to review the current literature on the use of amantadine in children who have sustained a head injury.

MAIN OUTCOMES AND RESULTS

A MEDLINE search was conducted and yielded five papers. They were composed of prospective, retrospective and case study designs. Dosage use and side effect profiles were consistent with expected norms. Efficacy was measures primarily by alertness and arousal and positive results were found for all studies on these dimensions. Behavioural and cognitive measures of outcome yielded mixed results.

CONCLUSIONS

The studies reviewed for this paper suggest that amantadine is clinically beneficial for children who have sustained head injuries. Double blind placebo controlled trials with larger sample sizes are needed to further substantiate these findings.

Gender and age effects on outcome after pediatric traumatic brain injury

OBJECTIVE

To evaluate whether girls have better outcomes after traumatic brain injury than boys.

DESIGN

Retrospective cohort study.

SETTING

University hospital.

PATIENTS

A 16,586 patient subset of the National Pediatric Trauma Registry with nonpenetrating traumatic brain injury.

INTERVENTIONS

Retrospective review.

MEASUREMENTS AND MAIN RESULTS

The patients were subdivided by age into prepubertal (0-7 yrs), indeterminate pubertal (8-12 yrs), and probable pubertal (13-19 yrs). All analyses were adjusted for injury severity using the Injury Severity Score. Outcome variables were in-hospital death rate, intensive care unit length of stay, total length of stay, discharge to home vs. rehabilitation, and functional status at discharge. Overall, 6.1% of girls and 5.3% of boys died. A higher proportion of girls were injured in motor vehicle crashes. Gender did not have a significant effect on in-hospital mortality rate after adjustment for age, Injury Severity Score, and motor vehicle crashes. Boys had a shorter intensive care unit length of stay (p =.027). There were no statistically significant differences between boys and girls in total hospital length of stay, functional outcome, and discharge location, although for every outcome there was a trend toward girls doing worse.

CONCLUSIONS

There is evidence from this large study that girls do not have a better outcome after pediatric traumatic brain injury than boys, with a suggestion that girls may do worse.

Developing experimental models to address traumatic brain injury in children

Traumatic brain injury (TBI) is the leading cause of injury-related death and disability among children under the age of 15 years in the United States. Epidemiological studies have revealed that even within the pediatric population there are differences in incidence, gender differences, causes, types of injuries sustained, and mortality within age subdivisions. This heterogeneity must be taken into account when developing appropriate models to address TBI in children. This review explores the current developmental TBI models, including fluid percussion, weight drop, and controlled cortical impact. It also addresses unique considerations to modeling pediatric brain injury that require special attention when modeling and designing studies: age appropriateness, injury severity, evaluation of recovery, plasticity, and anesthesia.

Winner of the young physician's section of the Gowers' prize 2000. Too good to be true? Thomas Willis--neonatal convulsions, childhood stroke and infanticide in seventeenth century England

A case of neonatal convulsion reported by Thomas Willis (1621-1675) together with its post mortem findings is quoted as being congenital intracerebral haemorrhage or strongly suggested as being the earliest pathological description of childhood cerebrovascular disease. However these authors only reviewed the incomplete written record left by Willis, describing how this case was the fourth consecutive child that the mother had lost to neonatal convulsions. The medical record is completed by notes taken by John Locke from a lecture delivered by Willis 3 or 4 years before the case was first published. Here, Locke relates how the mother subsequently had three further children who were all treated by Willis soon after birth and all survived uneventfully. Reviewing the post mortem findings and the full case histories modern medical science gives a different interpretation. Instead, I suggest that the case history given and pathological features described are more in keeping with a whiplash shaking injury than with cerebrovascular disease or a stroke. I believe that this is the earliest pathological description of shaking injury in childhood. We can never know why Willis did not publish the full success of his management of the subsequent children but it may have been due to his dramatic experience of a similar mother early on in his medical career.

Evaluation and management of children younger than two years old with apparently minor head trauma: proposed guidelines

OBJECTIVE

In children <2 years old, minor head trauma (HT) is a common injury that can result in skull fracture and intracranial injury (ICI). These injuries can be difficult to detect in this age group; therefore, many authors recommend a low threshold for radiographic imaging. Currently, no clear guidelines exist regarding the evaluation and management of head-injured infants. We sought to develop guidelines for management based on data and expert opinion that would enable clinicians to identify children with complications of HT and reduce unnecessary imaging procedures. METHODS.

EVIDENCE

References addressing pediatric HT were generated from a computerized database (Medline). The articles were reviewed and evidence tables were compiled. EXPERT PANEL: The multidisciplinary panel was comprised of nine experts in pediatric HT.

CONSENSUS PROCESS

A modified Delphi technique was used to develop the guidelines. Before the one meeting, panel members reviewed the evidence and formulated answers to specific clinical questions regarding HT in young children. At the meeting, guidelines were formulated based on data and expert consensus.

RESULTS

A management strategy was developed that categorizes children into 4 subgroups, based on risk of ICI. Children in the high-risk group should undergo a computed tomography (CT) scan. Those in the intermediate risk group with symptoms of possible ICI should either undergo CT scan or observation. Those in the intermediate risk group with some risk for skull fracture or ICI should undergo CT and/or skull radiographs or observation. Those in the low-risk group require no radiographic imaging.

CONCLUSIONS

We have developed a guideline for the evaluation of children <2 years old with minor HT. The effect of these guidelines on clinical outcomes and resource utilization should be evaluated.

Epidemiology of traumatic brain injury in children and adolescents in south-western Sweden

The objectives of this study were to outline the incidence, gender distribution, external causes, severity and early outcome of traumatic brain injury (TBI). The subjects were children and adolescents in the south-western Swedish health care region, aged 0-17 y in 1987-1991 and fulfilling the criteria for TBI. Identification was made from the discharge registers of the hospitals in the region admitting patients with TBI, and outcome data were obtained from medical records. The mean incidence rate was 12/100,000 for TBI. The dominant external cause was traffic (60%), followed by falls (22%). At discharge, 49% of those surviving were healthy, 48% suffered from one functional impairment and 52% suffered from two or more impairments. In conclusion, although the incidence rate of TBI is low in Sweden, the condition causes permanent functional impairment in 6/100,000 cases every year.

Transorbital penetrating brain injury caused by a toy arrow: a case report

A case of a 9-year-old boy with a transorbital toy-arrow injury to the brain is presented. At admission he was in coma (Glasgow Coma Scale of 6) with right hemiparesis and had a completely prolapsed left eye. Computerized tomography revealed intracranial haemorrhage and fracture of the orbital wall, which were treated conservatively. His left eye was enucleated due to massive injury. At the 6-month check-up the boy still show neurological signs of latent right hemiparesis. Disturbances, mostly cognitive, were noted on his psychological tests. A survey of the literature reveals no report of this nature in the paediatric age group. The necessity of continuous monitoring of new environmental risks as they occur, and the requirement for the prevention of recreational brain injuries in children, is stressed.

Paediatric head trauma: influence of age and sex. II. Biomechanical and anatomo-clinical correlations

A consecutive, unselected series of 1812 cases of head trauma in children less than 15 years of age and admitted hospital over a period of 8.5 years was studied. Data concerning the grade of energy involved, the ages of the victims, the types of pathologies caused and the clinical features noted were collected and statistically analysed. Babies and toddlers (0-3 years) were shown to sustain rather low-energy trauma and suffer more skull fractures, more subdural haematomas and more benign injuries. They lost consciousness less frequently and were less frequently in coma than the other children. By contrast, they had more frequent signs of lateralization, and early seizures were much more frequent in babies than in other children. Young children (3-9 years) had rather higher-energy accidents, frequently lost consciousness, were more frequently in coma and have more frequently had a free interval associated with the development of brain swelling. They did not suffer subdural effusion or contrecoup lesions. Schoolchildren (9-15 years) were statistically more or less like young adults: the clinical sequences of trauma were more severe than in the other children, mortality was a little bit higher, the risk of extradural haematoma was higher, and they rarely suffered subdural haematomas or contrecoup lesions. Traffic accidents, with higher energy involved, were more severe.