Causes leading to head trauma in children, clinical features and short term outcome - A prospective study

Abstract

Background : Head Trauma is very common in children. Although head trauma in children and adults have several similarities, children should not be considered as young adults, given that the pediatric patients have more susceptible cranial vault due to thinner and more pliable bones, open fontanelle, large head-to-torso ratio and less developed neck musculature.Many studies are done in developed nations with good quality of emergency care and facilities. Data is lacking in developing countries for epidemiology, mechanism of injury and different management modalities. So I would like to carry out this study in our setup to obtain data for the following lag backs. Methods : This is a prospective observational study conducted over a period of ten months from October 2017 to July 2017. All cases with head trauma requiring hospitalization in the study period(n=65) were enrolled. After a detailed primary and secondary survey, all of them were triaged and treated as per our protocol. All of them required neuroimaging. Parents or caretakers were thoroughly interrogated for the circumstances in which the children suffered head trauma, and were requested to provide the site photographs whenever possible Results : Of 65 children, 42(64.6%) were less than 5 years, 20(30.7%) were between 5-10 years and 3(4.7%) were more than 10 years. As per the protocol of our hospital, 33(50.7%) of them required admission to PICU or high dependency unit and 32(49.3%) required observation in general pediatric ward. Of 65 children, severe head trauma was seen in 8 (12.4%) children, requiring intensive management including mechanical ventilation, of which neurosurgical intervention was needed in three children. There were 3(4.6%) children with moderate head trauma and 54(83%) with mild head trauma. Neuroimaging was abnormal in all children with moderate and severe head trauma. Of those with mild head trauma, 39(72%) had abnormal neuroimaging. Results showed that 2 children expired, 3 had deficits in the form of unable to speak, not recognizing parents, not responding to verbal commands and facial nerve palsy. Remaining children were functionally normal. Analysis of circumstances leading to head trauma revealed that 38(58.5%) happened at home, 19(29.3%) on road, 8(12.3%) at play places. Poor safety precautions at home in the form of unsafe stairs (n=6, 9.2%), unsafe balconies (n=7, 10.8 %), unsupervised activities of kids (n=22, 33.9 %) were some of the preventable causes on domestic side. Unsafe road traffic, rash driving were also preventable situation. Play-places of children with insufficient supervision was the other important cause. Conclusion : Almost all the situations were preventable suggesting need to improve child safety practices. All severe and moderate head injuries and 72% of mild head injuries were associated with abnormal neuroimaging suggesting vulnerability of children to head trauma.