Epidemiology of paediatric minor head injury: Comparison of injury characteristics with Indices of Multiple Deprivation

Head injury among older adults and their clinical management: one year of emergency department attendances at a UK trauma center

OBJECTIVES

Primary: describe characteristics of adults aged ≥65 attending the Emergency Department (ED) at one major trauma center. Secondary: examine co-morbidities and complications; identify use of anticoagulant/antiplatelet medication among older adults presenting with Head Injury (HI); assess clinical management against UK guidelines.

METHODS

All ED admissions were screened prospectively to identify HI using case notes, hospital records and Trauma Audit Research Network data. Data were collected on demographics, cause and severity of injury, co-morbidities, anticoagulation/antiplatelet use, diagnostic imaging and discharge outcomes.

RESULTS

Over 12 months, 697 patients aged ≥65 years attended the ED for HI, representing over a quarter of adult ED attendances for HI. Mean age was 78.5 years (range 65-106), 395 (56.7%) were female. Most HIs were mild (93.5%) and 86% caused by falls. Three-quarters were discharged without hospital admission. Most had a preexisting medical condition andtaking medications prior to HI. Of these 116 were taking anticoagulants/antiplatelets but only 37 (31.9%) received a head CT scan. Half the patients were given a written HI information sheet at ED discharge.

CONCLUSIONS

Care of HI in older adults is challenging due to comorbidities. Practising evidence-based clinical management and following guidelines is important, but strict adherence is not common practice.

Head injuries in early childhood in the UK; is there a social gradient?

OBJECTIVES

To examine if there is a social gradient in early childhood head injuries among UK children.

METHODS

Cross-sectional study, using data from the UK Millennium Cohort Study (MCS). The second, third and fourth sweeps of the MCS were analysed separately, when children were 3, 5 and 7 years old. Logistic regression models were used to explore the associations between head injuries and family socioeconomic position (social class, household income, maternal education and area deprivation).

RESULTS

The unadjusted analyses showed different associations with socioeconomic indicators at different ages. At age 3 and 5 years, head injuries were associated with higher area deprivation, lower household income and parents not being in work or in the routine social class. At age 5 years head injuries were also associated with lower maternal education. At age 7 years only associations with area deprivation and maternal education were found. In adjusted analyses (mutually adjusted for all four socioeconomic indicators, maternal age, child age and child sex), the following associations were observed: at ages 3 and 5 years, higher levels of area deprivation were related to higher odds of head injuries. At age 3 years only, lower levels of maternal education were related to lower odds of head injuries. No social gradients were observed. At age 7 years, there were no significant associations between head injuries and any of the SEP measures.

CONCLUSION

We observed no social gradients in early childhood head injuries. However, at ages 3 and 5 years, head injuries were more frequently reported for children living in more deprived areas.

Design and implementation of a multifaceted injury prevention intervention in Bedouin children in southern Israel

BACKGROUND

Child injury is prevalent in the Bedouin community of southern Israel, with higher injury rates compared with the general population. Bedouin children aged 0-4 were twice as likely as children from other population groups to suffer any injury, and for example, incidence of burns in Bedouin children was 0.91/1000 children, compared with 0.46/1000 in Jewish children.

METHODS

A multifaceted injury prevention intervention was developed based on best practice methods, culturally adapted and implemented in nine Bedouin towns in collaboration with local authorities. Intervention elements included a youth leadership scheme, workshops for mothers in maternal child health centres, home safety visits, a preschool intervention and a media campaign. Outcome assessment of change following home visits was conducted. Process evaluation included a survey of mothers and focus groups with youth participants.

RESULTS

High participation was demonstrated indicating acceptability of the programme. Assessment of home visits showed an improvement in the level of household safety between first and second visits, as measured by a checklist. Youth participants expressed satisfaction in the programme, which gave them confidence and practical tools.

CONCLUSION

A multifaceted intervention programme was conducted in the Bedouin community in southern Israel and found to be acceptable, with high participation levels. Collaboration between national and local authorities improved implementation, and multiple programmes in different settings enabled broad exposure to the programme.

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.

Evaluation of an intervention to reduce child injury in Bedouin communities in Southern Israel

BACKGROUND

Child injury is particularly prevalent in low socioeconomic populations and minorities. In Israel, Bedouin children exhibit high rates of injuries and death. A multifaceted community intervention to reduce injury in children in and around the home was run in nine Bedouin communities in Southern Israel during 2014-2018. The aim of the study was to evaluate the effect of the intervention on injuries among children aged 0-4 by comparing emergency room (ER) visits and hospitalisations before and after the intervention.

METHODS

Child injury data (ages 0-4, 5-17) for 2013-2018 were obtained from Soroka Medical Center, including ER visits and hospitalisations. Further data on reason for hospitalisation and injury severity score (ISS) were obtained from the National Centre for Trauma Research for 2011-2018. Reach was assessed by calculating the per cent of participants from the total relevant population in each town. Poisson regression was used to assess change over time, from preintervention (2013) to postintervention (2018).

RESULTS

A high proportion of educational institutions took part in the intervention, and around 20% of relevant households received a home visit (n=6334). There was a significant reduction in ER visits (7.6%) in children aged 0-4 in 2018 compared with 2013. Hospitalisations did not decrease significantly, although the number of admissions for burns and falls was reduced significantly at follow-up.

CONCLUSIONS

This multifaceted intervention programme resulted in reduced injury in children aged 0-4 years in the Bedouin community. The use of simultaneous multiple intervention methods was effective in increasing child safety.

Examination of Racial Disparities in Adolescents Seen in the Emergency Department for Head, Neck, or Brain Injury

BACKGROUND

Given the frequency, severity, and attention of traumatic brain injury in children, benchmarking disparities and injury characteristics for adolescent patients is pivotal in understanding and enhancing both clinical care and outcomes.

OBJECTIVES

The purpose of this study was to investigate racial disparities on mechanism of injury, clinical outcomes, and social-health factors among adolescents treated in the emergency department (ED) for a head, neck, or brain injury.

METHODS

This study is the result of a retrospective chart review of head-, neck-, and brain-injured adolescent patients (n = 2857) treated at three community hospital EDs and one stand-alone ED. Outcome measures included patient demographics (gender, race/ethnicity, age), Glasgow Coma Scale score, hospital length of stay, intensive care unit length of stay, mechanism of injury, primary diagnosis, secondary diagnosis of a concussion, ventilation days, discharge disposition, and primary insurance.

RESULTS

There were racial differences in primary diagnosis, mechanism of injury, and insurance status. Results indicated that a higher proportion of white patients were diagnosed with a concussion compared with black patients (p < 0.001). Moreover, a higher proportion of white patients were seen in the ED for head, neck, or brain injury as a result of a sports or motor vehicle incident, whereas a leading mechanism among black patients was assault (p = 0.01). More white patients had private insurance, whereas more black patients had Medicaid (p < 0.001).

CONCLUSION

The disparities in mechanisms for which black and white adolescent patients are seeking care at the ED for head, neck, or brain injury help to identify social-health risks of sustaining a head, neck, or brain injury. These racial disparities between black and white adolescents seen at the ED for head, neck, or brain injury suggest the need for further research to better understand the national representation of these disparities.

Implications of Increased Weight Status for the Occurrence of Fall-Induced Intracranial Hemorrhage in Children Aged 4 Years or Younger

OBJECTIVES

The aim of this study was to investigate the association between increased weight status (IWS), a weight for age/sex at greater than the 95th percentile, and fall-induced intracranial hemorrhage (ICH) in children aged 4 years or younger.

METHODS

In 7072 children aged 4 years or younger with head injury who visited a tertiary care hospital emergency department in Korea from 2013 through 2015, the presence of fall-induced ICH was reviewed. The association between IWS and ICH was investigated by multivariable logistic regression. We retrospectively validated the Pediatric Emergency Care Applied Research Network rule alone and in combination with IWS for predicting ICH.

RESULTS

Of 7072 children, 547 (7.7%) underwent computed tomography, of whom 451 (6.4%) were enrolled. Of these, 41 (9.1%; estimated event rate, 0.6%) had ICHs, and 26 (5.8%) had IWS. Increased weight status was more common in the children with ICH (P = 0.023). The association between IWS and ICH remained significant after adjustment (odds ratio, 5.24; 95% confidence interval [CI], 1.49-18.46; P = 0.010). The validation of the rule in combination with IWS showed no significant increases in a sensitivity (92.7% [95% CI, 80.1%-98.5%] to 95.7% [95% CI, 83.5%-99.4%]) and negative predictive value (98.2% [95% CI, 94.7%-99.4%] to 98.8% [95% CI, 95.4%-99.8%]).

CONCLUSIONS

Increased weight status is associated with fall-induced ICH in children aged 4 years or younger. Information on weight status could be potentially helpful in predicting ICH in young children with fall-induced head injury.

A secondary analysis to inform a clinical decision rule for predicting skull fracture and intracranial injury in children under age 2

The purpose of this study was to identify factors associated with the risk of closed head injury (CHI) in children under age 2 years with suspected minor head injuries based on age-appropriate, or near age-appropriate, mental status on an exam. The study was a secondary data analysis of a public-use dataset from the largest prospective, multicenter pediatric head injury study found in the current literature. An existing, validated clinical decision rule was examined using a sample of 3,329 children under age 2 to determine whether it, or the individual variables within it, could be utilized alone, or in conjunction with other variables to accurately predict the risk of underlying CHI in this sample. Results indicated that the keys to an accurate triage assessment for children under age 2 with suspected minor head injuries include the ability to identify the specific skull region injured, the ability to assess for the presence and size of any scalp hematoma, the ability to identify signs of altered mental status in this age group, and having access to accurate information regarding the child's age and the details of the injury mechanism. The findings from this study add to the body of knowledge regarding what factors are associated with CHI in children under age 2 with suspected minor head injuries and could be used to inform age-specific recommendations for children under age 2 in triage, educational resources, and national trauma criteria.

To what extent are GCS and AVPU equivalent to each other when assessing the level of consciousness of children with head injury? A cross-sectional study of UK hospital admissions

OBJECTIVE

To evaluate utility and equivalence of Glasgow Coma Scale (GCS) and the Alert, Voice, Pain, Unresponsive (AVPU) scale in children with head injury.

DESIGN

Cross sectional study.

SETTING

UK hospital admissions: September 2009-February 2010.

PATIENTS

<15 years with head injury.

INTERVENTIONS

GCS and/or AVPU at injury scene and in emergency departments (ED).

MAIN OUTCOME

Measures used, the equivalence of AVPU to GCS, GCS at the scene predicting GCS in ED, CT results by age, hospital type.

RESULTS

Level of consciousness was recorded in 91% (5168/5700) in ED (43%: GCS/30.5%: GCS+AVPU/17.3%: AVPU) and 66.1% (1190/1801) prehospital (33%: GCS/26%GCS+AVPU/7%: AVPU). Failure to record level of consciousness and the use of AVPU were greatest for infants. Correlation between AVPU and median GCS in 1147 children <5 years: A=15, V=14, P=8, U=3, for 1163 children ≥5 years: A=15, V=13, P=11, U=3. There was no significant difference in the proportion of infants who had a CT whether AVPU=V/P/U or GCS<15. However diagnostic yield of intracranial injury or depressed fracture was significantly greater for V/P/U than GCS<15 :7/7: 100% (95% CI 64.6% to 100%) versus 5/17: 29.4% (95% CI 13.3% to 53.1%). For children >1 year significantly more had a CT scan when GCS<14 was recorded than 'V/P/U only' and the diagnostic yield was greater. Prehospital GCS and GCS in the ED were the same for 77.4% (705/911).

CONCLUSION

There was a clear correlation between Alert and GCS=15 and between Unresponsive and GCS=3 but a wider range of GCS scores for responsive to Pain or Voice that varied with age. AVPU was valuable at initial assessment of infants and did not adversely affect the proportion of infants who had head CT or the diagnostic yield.

Risk of mild head injury in preschool children: relationship to attention deficit hyperactivity disorder symptoms

AIM

To investigate whether there is an association between mild head injury (MHI) and attention deficit hyperactivity disorder (ADHD) symptoms in preschool children.

METHODS

The study included a patient group of 30 children aged 3-6 years with mild head trauma and a control group of 30 healthy and age- and sex-matched children. The symptoms of ADHD were evaluated using the Conners' Parent Rating Scale-Revised Long (CPRS-RL) form.

RESULTS

The mean age was 4.73 ± 1.13 years in the patient group and 4.65 ± 0.99 years in the control group. No significant differences were determined between the groups in terms of age, gender, parents' age and education (p > 0.05). The total subscale points as reported by the parents of the children with MHI were significantly higher than those for the control group in terms of the following subscales: oppositional, cognitive problems/inattention, hyperactivity, social problems, ADHD index, Conners' Global Index (CGI)-Irritability-Impulsiveness, CGI-Emotional Lability, CGI-Total and DSM-IV ADHD symptoms (p < 0.05). A history of previous trauma treated in emergency services was determined in eight of the 30 patients (26.7%).

CONCLUSIONS

The findings of this study suggest that preschool children with MHI have more pre-injury ADHD symptoms and oppositional and emotional-behavioural symptoms than healthy children without trauma. Clinicians should screen children with MHI for ADHD symptoms and refer them for treatment when necessary. Evaluation of children presenting with MHI by a child psychiatrist may prevent repetition of injuries.

Estimating the global incidence of traumatic brain injury

OBJECTIVETraumatic brain injury (TBI)-the "silent epidemic"-contributes to worldwide death and disability more than any other traumatic insult. Yet, TBI incidence and distribution across regions and socioeconomic divides remain unknown. In an effort to promote advocacy, understanding, and targeted intervention, the authors sought to quantify the case burden of TBI across World Health Organization (WHO) regions and World Bank (WB) income groups.METHODSOpen-source epidemiological data on road traffic injuries (RTIs) were used to model the incidence of TBI using literature-derived ratios. First, a systematic review on the proportion of RTIs resulting in TBI was conducted, and a meta-analysis of study-derived proportions was performed. Next, a separate systematic review identified primary source studies describing mechanisms of injury contributing to TBI, and an additional meta-analysis yielded a proportion of TBI that is secondary to the mechanism of RTI. Then, the incidence of RTI as published by the Global Burden of Disease Study 2015 was applied to these two ratios to generate the incidence and estimated case volume of TBI for each WHO region and WB income group.RESULTSRelevant articles and registries were identified via systematic review; study quality was higher in the high-income countries (HICs) than in the low- and middle-income countries (LMICs). Sixty-nine million (95% CI 64-74 million) individuals worldwide are estimated to sustain a TBI each year. The proportion of TBIs resulting from road traffic collisions was greatest in Africa and Southeast Asia (both 56%) and lowest in North America (25%). The incidence of RTI was similar in Southeast Asia (1.5% of the population per year) and Europe (1.2%). The overall incidence of TBI per 100,000 people was greatest in North America (1299 cases, 95% CI 650-1947) and Europe (1012 cases, 95% CI 911-1113) and least in Africa (801 cases, 95% CI 732-871) and the Eastern Mediterranean (897 cases, 95% CI 771-1023). The LMICs experience nearly 3 times more cases of TBI proportionally than HICs.CONCLUSIONSSixty-nine million (95% CI 64-74 million) individuals are estimated to suffer TBI from all causes each year, with the Southeast Asian and Western Pacific regions experiencing the greatest overall burden of disease. Head injury following road traffic collision is more common in LMICs, and the proportion of TBIs secondary to road traffic collision is likewise greatest in these countries. Meanwhile, the estimated incidence of TBI is highest in regions with higher-quality data, specifically in North America and Europe.

Soft-tissue evidence of head injury in infants and young children: is CT head examination justified?

AIM

To determine whether it is justified to undertake a computed tomography (CT) examination of the head in children under 1 year of age who present with a bruise, swelling, or laceration of >5 cm following head injury in children presenting to a paediatric accident and emergency (A&E) department in the northwest of England. Further aims were to determine whether there was any justification for performing a CT head examination for children with soft-tissue injuries measuring <5 cm, or for children >1 year with evidence of soft-tissue injury, but without any other concerning feature.

MATERIALS AND METHODS

Children <3 years of age presenting with soft-tissue evidence of head injury between May 2011 and Oct 2014 and who subsequently underwent head CT were retrospectively identified from radiology requests. The CT images and clinical notes were used to identify those with skull fracture or intracranial haemorrhage and to determine whether the child was subsequently admitted or discharged from A&E.

RESULTS

Eighty-five CT head examinations met the criteria for inclusion. Of these, 45 examinations demonstrated skull fractures and four examinations identified intracranial haemorrhage. Thirty-eight requests included soft-tissue evidence of head injury as the sole reason indicated for CT head examination. Of these, 22 examinations demonstrated skull fractures and one examination identified intracranial haemorrhage.

CONCLUSION

Soft-tissue evidence of head injury as the sole reason for CT head examination appears to be justified in the present patient population. Furthermore, this study suggests that CT head examination should also be considered for children with soft-tissue injuries of <5 cm and for children aged between 1 and 3 years if identification of a skull fracture would alter the child's management.

Mild head injury and attention deficit hyperactivity disorder in children

PURPOSE

Post-concussion syndrome is a well-described complication following moderate and severe head trauma but whether it occurs after mild head injury in children remains unclear. The aim of this study was to evaluate whether exposure to mild head injury with potential additional risk factors (non-surgical lesion on computed tomographic, high kinetic trauma, or Glasgow Coma Scale <15) is associated with attention deficit hyperactivity disorder (ADHD) after the head trauma.

METHODS

This study was performed in an emergency department on children admitted between 2009 and 2013. It compared victims of mild head injury aged 6-16 years with matched children presenting isolated non-surgical forearm fracture (ratio1/2). ADHD was assessed using Conners' Global Index-Parent short version 3-40 months after the trauma. The patients were compared using chi-square test or Fisher's exact test, t test or u-test as appropriate with a p value set at 0.05.

RESULTS

During the study period, 676 patients were admitted for mild head injury. Among them, 34 (5 %) fulfilled the inclusion criteria and were compared with 64 matched patients admitted for a forearm fracture. The groups were comparable. ADHD was observed in both groups (18 % in the mild head injury group, 11 % in the control group) with no significant differences between groups. The prevalence was high when compared to an expected frequency of 3.5-5.6 % in children aged 6-12 years in the general population.

CONCLUSIONS

These results suggest that pre-existing ADHD may have contributed to injury proneness in both groups and does not argue for a specific risk of ADHD induced by mild head injury. The diagnosis of ADHD should be evoked at admission of children aged 6-16 years presenting with a trauma.

Epidemiology of children with head injury: a national overview

BACKGROUND

The National Confidential Enquiry describes the epidemiology of children admitted to hospital with head injury.

METHOD

Children (<15 years old) who died or were admitted for >4 h with head injury were identified from 216 UK hospitals (1 September 2009 to 28 February 2010). Data were collected using standard proformas and entered on to a database. A descriptive analysis of the causal mechanisms, child demographics, neurological impairment, CT findings, and outcome at 72 h are provided.

RESULTS

Details of 5700 children, median age 4 years (range 0-14.9 years), were analysed; 1093 (19.2%) were <1 year old, 3500 (61.4%) were boys. There was a significant association of head injury with social deprivation 39.7/100 000 (95% CI 37.0 to 42.6) in the least deprived first quintile vs. 55.1 (95% CI 52.1 to 58.2) in the most deprived fifth quintile (p<0.01). Twenty-four children died (0.4%). Most children were admitted for one night or less; 4522 (79%) had a Glasgow Coma Scale score of 15 or were Alert (on AVPU (Alert, Voice, Pain, Unresponsive)). The most common causes of head injury were falls (3537 (62.1%); children <5 years), sports-related incidents (783 (13.7%); median age 12.4 years), or motor vehicle accidents (MVAs) (401 (7.1%); primary-school-aged children). CT scans were performed in 1734 (30.4%) children; 536 (30.9%) were abnormal (skull fracture and/or intracranial injury or abnormality): 269 (7.6%) were falls, 82 (10.5%) sports related and 100 (25%). A total of 357 (6.2%) children were referred to social care because of child protection concerns (median age 9 months (range 0-14.9 years)).

CONCLUSIONS

The data described highlight priorities for targeted age-specific head injury prevention and have the potential to provide a baseline to evaluate the effects of regional trauma networks (2012) and National Institute of Health and Care Excellence (NICE) head injury guidelines (2014), which were revised after the study was completed.

The risk of intra-cranial haemorrhage in those presenting late to the ED following a head injury: a systematic review

BACKGROUND

Head injury represents an extremely common presentation to emergency departments (ED), but not all patients present immediately after injury. There is evidence that clinical deterioration following head injury will usually occur within 24 h. It is unclear whether this means that head injury patients that present in a delayed manner, especially after 24 h, have a lower prevalence of significant traumatic injuries including intra-cranial haemorrhages.

METHODS

A systematic review protocol was designed with the aim of systematically identifying and evaluating studies in delayed ED presentation head injury populations in order to establish whether the prevalence of significant intra-cranial injury was affected by delay in presentation. Two independent researchers assessed retrieved studies for inclusion against pre-determined inclusion criteria. Studies had to be conducted in ED head injury populations presenting in a delayed manner, and report a measure of prevalence of traumatic CT abnormality as an outcome.

RESULTS

Three studies were eligible for inclusion. They were all of poor methodological quality, and heterogeneity prevented meta-analysis. The reported prevalence of traumatic intra-cranial injury on CT was between 2.2 and 6.3%. This is generally lower than reported in the literature for non-delayed presentation head injury populations.

CONCLUSIONS

Available evidence suggests that head injury patients who present in a delayed fashion to the ED may have lower rates of intra-cranial injury compared to non-delayed head injury patients. However, the evidence is sparse and it is of too low quality to guide clinical practice. Further research is required to help the clinical risk assessment of this group.

TRIAL REGISTRATION

PROSPERO

CRD42015016135.

Childhood injury in Tower Hamlets: Audit of children presenting with injury to an inner city A&E department in London

INTRODUCTION

Childhood injury is a leading cause of mortality and morbidity worldwide with the most socio-economically deprived children at greatest risk. Current routine NHS hospital data collection in England is inadequate to inform or evaluate prevention strategies. A pilot study of enhanced data collection was conducted to assess the feasibility of collecting accident and emergency data for national injury surveillance.

AIMS

To evaluate the reliability and feasibility of supplementary data collection using a paper-based questionnaire and to assess the potential relationship between income deprivation and incidence of paediatric injury.

METHODS

Clinical staff conducted an audit of injuries in all patients under 16 years between June and December 2012 through completion of a questionnaire while taking the medical history. Descriptive statistics were produced for age, sex, time of arrival, activity at time of injury, mechanism and location of injuries. The association between known injury incidence and area level income deprivation (2010 English Index of Multiple Deprivation [IMD] Income Deprivation Domain from home postcode) was assessed using Spearman's rank correlation. Representativeness of the audit was measured using z-test statistics for time of arrival, age, sex and ethnicity.

RESULTS

The paper audit captured 414 (6.5%) of the 6358 under-16 injury-related attendances recorded on the NHS Care Record Service Dataset. Comparison of the audit dataset with NHS records showed that the audit was not representative of the larger dataset except for sex of the patient. There was a positive correlation between injury incidence and income deprivation measured using IMD score where data were available (n = 384, p < 0.001). Nearly half of the attendances were due to falls, slips or trips (49.8%) and more than half were due to either leisure (32.9%) or sport (18.1%) activities.

CONCLUSION

There is evidence of area level income inequalities in injury incidence among children attending the Royal London Hospital. The audit failed to capture a high proportion of cases, likely due to the paper-based format used. This study highlights the importance of routinely collecting enhanced injury data in computerized hospital admission systems to provide the necessary evidence base for effective injury prevention. The findings have contributed to plans for implementation.

Chronic post-traumatic headache in pediatrics

SUMMARY 

Both primary headaches and minor head injuries are common in children. If headache presents for the first time or becomes exacerbated soon after head injury it is described as post-traumatic headache (PTH). Acute PTH resolves within 3 months from injury, but chronic PTH continues beyond 3 months. The pathogenesis of PTH is not well understood. Several mechanisms were proposed such as axonal injuries and disturbances of cerebral metabolic processes. The clinical features of PTH are those of primary headache disorders such as migraine and tension-type headache and usually follow a favorable prognosis. Investigations and management should therefore be relevant to the type of headache and focused on clinical needs of the child.