Head Injury In Children Research Articles

Minor Head Injuries in Children

Traumatic head injury continues to be a major problem facing the pediatric specialists despite efforts to reduce its incidence. Aims of our study were assessment of the incidence of hospital admissions of children with minor head injuries, their treatment and outcome. In this prospective study we included 101 patient with head injury. We assessed the hospital admission criteria of children with minor head injuries, their length of stay, symptoms and neurological status, in-hospital imaging and consultations to other medical specialities, together with the outcome of patients on their discharge from the hospital. Of 101 patient 54 (53.46%) were male and 47 (46.53%) female. Average age was 3 years with age range from 5/52 to 12 years. Majority of patients (46.53%) were less than 1 year old. Fall was the most common mechanism of injury (92.07% of all patients). Injuries were witnessed in 51 case (50.49%), unwitnessed in 19 cases (18.81%) and unknown in 31 cases (30.69%). 95 patients did not have associated extracranial injuries, while 5 patients had associated lacerations and one had associated extracranial fracture. Length of stay was from 1 day in 80.19% of all cases to more than 2 days in 6.93%. GCS was recorded on admission and discharge and majority of patients were discharged with GCS of 15. 93% of admissions had no neurological deficit. 79% had 1 or more symptoms including vomiting, sleepiness, LOC and headaches. Over half of patients (55%) had no imaging done. 45 patients (45%) had skull x-ray. CT was performed in 7 (15%) patients and 7 fractures were found on x-ray and CT. 3 patients were admitted to ICU. All injuries were closed and all received conservative treatment. In less than 1 year old group of patients 95% of them were also seen by medical team and social worker. The outcome was good for all patients. We conclude that majority of patients with minor head injury could be supervised and observed at home by a competent care giver. Admitted patients need radiological evaluation, preferably a CT scan. Language: en

Head Injury in Children

Head Injury in Children

Childhood head injury, control beliefs, and later life cognitive function in the Health and Retirement Study

AbstractBackgroundMild traumatic brain injury earlier in life is a risk for dementia later in life. While research has rightly focused attention on strategies for reducing the risk of incurring brain injury in youth, less attention has been paid to potentially modifiable risk factors for dementia in the context of a sustained childhood brain injury. Psychosocial resources may play an important role in mitigating the risk of dementia associated with early life brain injury. We investigated the role of control beliefs in the relationship between early life brain injury and cognitive functioning in the Health and Retirement Study.MethodData were from four biennial waves of HRS, combining 2006 and 2008 (time 1) and 2010 and 2012 (time 2) (n=5,999). A linear regression model evaluated the relationship between self‐reported head injury ("Before you were 16 years old, did you have a blow to the head, a head injury or head trauma that was severe enough to require medical attention, to cause loss of consciousness or memory loss for a period of time") and perceived control at time 1. A second examined the relationship between self‐reported head injury at time 1 and working memory (immediate and delayed recall) at time 2, controlling for working memory at time 1. A final model examined control beliefs as a potential mediator. Controls included age, race, gender, depression, health conditions, education, and income.ResultMean age was 65.4 years, 78.2% White, 10.1% Black, 5% Latino, 6.5% other, and 10.1 percent reported early head injury. Those with a history of head injury in childhood reported lower personal control beliefs at time 1 (p<.001). History of childhood head injury (time 1) were modestly associated with working memory at time 2, after controlling for baseline working memory (p<.05). Control beliefs partially mediated this relationship.ConclusionHRS respondents with a self‐reported history of head injury in childhood reported lower personal control beliefs. In turn, control beliefs mediated the relationship between early head injury and later life working memory. Personal control beliefs may be an important modifiable risk for cognitive decline among those with a history of childhood head injury.

Identification of practically important traumatic brain injury using Pediatric Emergency Care Applied Research Network rule in children younger than 2 years with minor head trauma

Background:Minor head trauma is frequently presented to the pediatric emergency department. Despite the burden this injury poses on public health, evidence-based clinical guidelines on the assessment and management of pediatric minor head trauma remain unestablished, particularly in children below 2 years. We aimed to assess the diagnostic accuracy of a clinical decision rule (Pediatric Emergency Care Applied Research Network rule) and physician discretion in the recognition of practically important traumatic brain injury in children below 2 years of age presenting with minor head trauma to the emergency department.Methods:The medical records of children younger than 2 years presenting with head trauma to the emergency department were reviewed with Glasgow Coma Scale scores of 14–15. Practically important traumatic brain injury is a clinically essential traumatic brain injury including all cranial abnormalities (e.g. skull fracture) detected by computed tomography. All predictor variables of the Pediatric Emergency Care Applied Research Network rule and practically important traumatic brain injury outcomes were validated.Results:We enrolled and analyzed 433 children below 2 years. The most frequently observed mechanisms of injury in decreasing order were as follows: falls > 90 cm, head struck by high-impact objects, slip down, and automobile traffic accident. Of 224 children, positive findings were observed in 35 and 144 had one or more predictors of Pediatric Emergency Care Applied Research Network rule. The sensitivity, specificity, and negative likelihood ratio of the Pediatric Emergency Care Applied Research Network rule for practically important traumatic brain injury were 94.3%, 41.3%, and 0.14, respectively.Conclusion:The Pediatric Emergency Care Applied Research Network rule would assist in clinical decision-making to appropriately detect potential head injuries in children below 2 years, thereby reducing unnecessary performance of computed tomography scan.

268 Comparing Pediatric Head CT Rules Using Outcomes for Acute Lifesaving Intervention

Rates of pediatric head CT for mild blunt head trauma (BHT) have not shown improvement while published clinical prediction rules (CDRs) have been available. Outcomes for these CDRs may be too inclusive and set the threshold to scan unreasonably low. We sought to compare the sensitivity of five published CDRs in detecting outcomes limited to the need for acute lifesaving intervention. We conducted a retrospective chart review of patients <18 years old presenting to the ED between the years 2006 through 2013 at a single academic Level 1 Pediatric Trauma Center with diagnoses consistent with intracranial injury and who received head CT as part of their management. Patients meeting criteria for mild non-penetrating BHT (GCS 14-15) were screened for the following outcomes indicating a need for acute lifesaving intervention: neurosurgical procedure, intubation due to head injury, and death. The five following CDRs were then assessed for their ability to detect patients with these outcomes: the Pediatric Emergency Care Applied Research Network (PECARN) CT head rule, the Canadian Assessment of Tomography for Childhood Head injury 2 (CATCH2) rule, the Children’s Head injury ALgorithm for prediction of Clinically Important Events (CHALICE), the Pediatric National Emergency X-Radiography Utilization Study II (NEXUS II) Head CT Decision Instrument, and the decision rule developed by Palchak et al. Out of 1,810 patients with diagnosis codes consistent with intracranial injury and that received CT, 1,162 met the criteria for mild non-penetrating BHT and were screened for the outcomes of interest. 21 patients had one or more of the three outcomes, representing 1.8% of those screened. The average age was 4.6 years and the majority (62%) were male. All 21 patients required intubation due to their head injury with 9 receiving a neurosurgical procedure (0.8%) and no deaths. All CDRs displayed 100% sensitivity with each patient meeting at least 1 criterion for each CDR. All CDRs displayed 100% sensitivity at detecting outcomes indicating a need for acute lifesaving intervention in pediatric mild BHT. Future prospective studies should consider similar outcomes to assess their utility in decreasing unnecessary pediatric head CT.

Which Clinical Features of Children on Initial Presentation to the Emergency Department With Head Injury Are Associated With Clinically Important Traumatic Brain Injury, Classification as Abuse, and Poor Prognosis?

Pediatric traumatic brain injury (TBI) and abusive head trauma (AHT) are leading causes of morbidity and mortality. Clinicians may not be aware of AHT at presentation to the emergency department (ED). The objective of this study was to determine which clinical features associated with head injury in children on initial presentation to the ED trauma bay predict 3 outcomes including clinically important TBI (CiTBI), classification as confirmed abuse by Child Protection Team (CPT), and poor neurologic status on hospital discharge. Inclusion for this study were children 3 years or younger, presenting to the ED with significant TBI. In addition, presentations where the mechanism of injury was not verifiable such as with falls, being struck by object, or no mechanism of injury reported by caregiver were included. Researchers used 3 sources of information for this analysis: a regional trauma registry, hospital records, and the CPT database. Clinical features included demographics, mechanisms of injury, physical, radiological findings, and CPT classification. On pairwise analysis, seizures, apnea, and no mechanism of injury reported by caregiver were the only clinical features related to all 3 outcomes (P < 0.001). Rib fractures (relative risk [RR], 3.3; P < 0.001), long bone fractures (RR, 3.1; P < 0.001), retinal hemorrhages (RR, 3.0; P < 0.001), seizures (RR, 3.6; P < 0.001), apnea (RR, 4.4; P < 0.001), and younger than 6 months (RR, 1.8; P < 0.001) were related to AHT. On multivariable logistic regression, no mechanism of injury reported by caregiver and seizures remained significantly related to CiTBI; seizures and retinal hemorrhage remained significantly related to classification as abuse by CPT, and no mechanism of injury by the caregiver, apnea, and seizures were significantly related to poor outcome on hospital discharge. No mechanism of injury reported by the caregiver, seizures, and apnea at the time of presentation to the ED are important features associated with CiTBI, classification as AHT, and poor prognosis. In addition, younger age, retinal hemorrhage, rib, and long bone fractures were found to be important clinical features associated with AHT.

Radiologic Assessment of Skull Fracture Healing in Young Children.

BackgroundSkull fractures are commonly seen after both accidental and nonaccidental head injuries in young children. A history of recent trauma may be lacking in either an accidental or nonaccidental head injury event. Furthermore, skull fractures do not offer an indication of the stage of healing on radiologic studies because they do not heal with callus formation as seen with long bone fractures. Thus, a better understanding on the timing of skull fracture resolution may provide guidance on the medical evaluation for accidental or nonaccidental head injury.ObjectiveThe aim of the study was to determine the time required for radiographic skull fracture resolution in children younger than 24 months.MethodsThis was a retrospective observational analysis of children younger than 24 months referred with skull fractures between January 2008 and December 2012. Analysis included children with accidental head injuries with a known time interval since injury and a negative skeletal survey who underwent serial radiographic studies. Complete healing of a skull fracture was defined as resolution of fracture lucency by radiograph.ResultsOf the 26 children who met inclusion criteria, 11 (42.3%) demonstrated resolution of skull fracture(s) on follow-up imaging. Fracture resolution on radiologic studies ranged from 2 to 18 weeks. Twelve fractures in 10 children demonstrated fracture resolution at 10 or more weeks after injury.ConclusionsHealing or resolution of a skull fracture can take months in children younger than 24 months. With the high variability in skull fracture presentation and large window to fracture resolution, unexplained or multiple skull fractures in children younger than 24 months may be the result of a single or multiple events of head trauma.

Epidemiology of soccer-related head injury in children 5-14 years in Victoria, Australia.

Our aim was to use epidemiological data to determine the incidence of soccer-related head injuries in children aged 5-14 years who presented at emergency departments (EDs) or were admitted in hospitals in Victoria, Australia. ED presentation and hospital admission de-identified aggregate data were from the Victorian Injury Surveillance Unit. Soccer participation data were compared with the soccer-related head injury data to determine the incidence of this injury among these children. The incidence of ED presentations was 0.17% of children participating in soccer during the study period (financial years 2011-2012 to 2015-2016). The 10-14-years age group presented with more head injuries than the 5-9-years age group. For the admissions data, soccer had a significantly lower (P = 0.0379) incidence of head injury when compared with 'sport as a whole'. The low incidence of soccer-related head injuries presenting to an ED or admission to hospital is consistent with international findings.

The comparison of PECARN, CATCH, AND CHALICE criteria in children under the age of 18 years with minor head trauma in emergency department

Introduction: Minor head traumas constitute a significant part of childhood injuries. The incidence of intracranial pathologies in children with minor head trauma varies in the range of 3%–5%, but it is higher among younger infants. The criteria of the Pediatric Emergency Care Applied Research Network, Canadian Assessment of Tomography for Childhood Head Injury, and Children’s Head Injury Algorithm for the Prediction of Important Clinical Events are the most frequently accepted clinical decision-making criteria that were developed for selective computerized tomography requests. This study was conducted to assess the diagnostic performances of the Pediatric Emergency Care Applied Research Network, Canadian Assessment of Tomography for Childhood Head Injury, and Children’s Head Injury Algorithm for the Prediction of Important Clinical Events criteria in Turkish society, determine their validity, and find the most suitable algorithm for cranial imaging in children with minor head trauma. Methods: This study retrospectively examined the data of patients under the age of 18 years who were admitted to the Emergency Medicine Department of Uludağ University Medical Faculty due to minor head trauma; 530 patients were included as they complied with the criteria. The exclusion criteria were being any trauma patients above the age of 18 years, Glasgow Coma Scale &lt;13, pregnant patients, hemorrhagic diathesis, using anticoagulants, patients with penetrant trauma, patients with priorly known brain tumor, and patients with neurological diseases. The patients were divided into group based on the Pediatric Emergency Care Applied Research Network, Canadian Assessment of Tomography for Childhood Head Injury, and Children’s Head Injury Algorithm for the Prediction of Important Clinical Events Criteria. Results: Among all patients, 37.40% were female and 62.60% were male. Abnormal computed tomography findings such as epidural bleeding, subdural bleeding, and skull fractures were detected in 44 of the patients. The sensitivity of the Pediatric Emergency Care Applied Research Network criteria was 72.4%, the specificity was 54.5%, the sensitivity of the Canadian Assessment of Tomography for Childhood Head Injury criteria was 57.8%, the specificity was 50%, the sensitivity of the Children’s Head Injury Algorithm for the Prediction of Important Clinical Events criteria was 87.7%, and the specificity was 20%. Conclusion: Given the populations to which the rules apply, it is understood that the Children’s Head Injury Algorithm for the Prediction of Important Clinical Events criteria is more determinative in detecting pathological computed tomography outcomes compared to Pediatric Emergency Care Applied Research Network and Canadian Assessment of Tomography for Childhood Head Injury.

Telephone Triage in Pediatric Head Injury: Follow-up Patterns and Subsequent Diagnosis of Concussion.

Head injuries in childhood can result in concussion. Families of a child with a head injury often seek medical advice through telephone triage call systems. It is important to understand if patients follow telephone triage recommendations and what proportion of triage calls result in subsequent concussion diagnosis. We used a one-year retrospective cohort of triage calls screened with the Barton Schmitt Pediatric Head Injury Telephone Triage Protocol. The objectives were to estimate the proportion who followed up with urgent recommendations to see a provider and determine prevalence of diagnoses of concussion. Out of 2,454 calls with recommendations to be seen urgently, the estimated proportion of being seen in the medical home network or an outside health care facility was 84.1%. Estimated overall diagnoses of concussion among those who were seen was 39.5%. These data can be used to improve patient education and follow-up, as well as the utility of the telephone triage system.

Ceiling Fan-Related Head Injuries in Children: A Queensland Neurosurgical Experience

Introduction: Ceiling fans are a widespread energy-efficient appliance required for managing the sweltering weather extremes encountered in northern Australian states including Queensland. Ceiling fans are also a rare cause of serious head injury in children requiring neurosurgical intervention. There is limited available evidence on the presentation, mechanism, and management of these injuries. Methods: A retrospective analysis of children who suffered ceiling fan injuries admitted to the Queensland Children’s Hospital, a level-1 paediatric trauma hospital in Brisbane, Queensland, under the neurosurgery unit from November 2014 to July 2018 was performed. Results: Seventeen children (64.7% male) with a mean age of 4.24 years (range 0.66–7.25) sustained ceiling fan injuries requiring neurosurgical management during this period. Children were injured following being accidentally lifted or thrown into the ceiling fan path; jumping, playing, climbing, or being pushed from a bunk bed; or climbing on other furniture. All patients suffered skull fractures (88.2% depressed), and 65% suffered extra-axial or intracerebral haemorrhage. Operative management was required in 76.5% of the patients. No patients suffered adverse outcomes, and no complications, including infections, were recorded. Conclusions: Despite their rarity, paediatric ceiling fan injuries requiring neurosurgical management are a cause of significant morbidity. Surgical management targeted elevation of depressed fractures and washout of open fractures rather than evacuation of intracranial collections. Almost all included patients required transfer with associated social and economic implications. Such injuries are largely preventable with improved supervision and safety awareness. Hazard modification may be extended to regulatory changes or improved ceiling fan design.

Traumatic epidural hematomas in the pediatric population: clinical characteristics and diagnostic pitfalls

Background/PurposeThe purpose of this study was to review the initial clinical presentation of EDH, identify potential clinical markers and highlight diagnostic pitfalls. MethodsRetrospective review of all pediatric patients admitted to a Level I Trauma Center diagnosed with blunt traumatic EDH from 2008 to 2018. ResultsA total of 699 pediatric patients were identified with blunt traumatic brain injury (TBI); 106 with EDH made up the study population. A skull fracture was present in 84%. Overall, the most common clinical finding was a scalp hematoma (86%), followed by loss of consciousness (66%), emesis (34%), headache (27%), amnesia (18%), and seizures (12%). Importantly, 40% of patients with EDH presented with GCS 15. Four children (4%) had GCS 15 and were completely asymptomatic on admission. In three children (3%) the only symptom was a scalp hematoma. 50% of all EDH required craniotomy, and this was not significantly different if GCS was 15 on presentation (45%, p = 0.192). Mortality was 2%. Fourteen patients (13%) were discharged with cognitive/motor deficits. ConclusionsPediatric EDH frequently present with subtle clinical signs, including a normal GCS half the time.Irrespective of asymptomatic presentation, threshold for CT scan or an observation period should be low after head injuries in children. Type of studyPrognosis study. Level of EvidenceLevel II/III.

Computed tomography in the forensic medical diagnosis of brain injury

The observation reveals the diagnostic capabilities of computed tomography to address issues arising in the implementation of forensic medical examinations. It considers a case of computed tomography used to determine the nature of brain injury in a 1-month-old baby. Cranial injuries detected by computed tomography had characteristic signs indicating the compression mechanism of causing brain injury. An interdisciplinary approach made it possible to exclude causes for a child's head injuries resulting from a fall.

Validation of the pediatric stroke outcome measure for classifying overall neurological deficit.

The pediatric stroke outcome measure (PSOM) is a standardized, disease-specific outcome measure. We aimed to validate the overall classification of neurological deficit severity using PSOM. We identified 367 neonates/children with arterial ischemic stroke (AIS) (Derivation Cohort). We analyzed the PSOM subscales (scored as 0 [no deficit], 0.5 [minimal/mild deficit; normal function], 1 [moderate deficit; slowing function], or 2 [severe deficit; missing function]) to derive severity levels using latent class analysis (LCA). We validated a severity classification scheme (PSOM-SCS) in: (a) children who had Pediatric Evaluation of Disability Inventory (PEDI; n = 63) and/or the Pediatric Quality-of-Life Inventory (PedsQL; n = 97) scored; and (b) an external cohort (AIS; n = 102) with concurrently scored modified Rankin Scale (mRS), King's Outcome Scale for Childhood Head-Injury (KOSCHI) and PSOM. Within the Derivation Cohort, LCA identified three severity levels: "normal/mild," "moderate," and "severe" (83.7%, 13.3%, and 3%, respectively). We developed severity classification based on PSOM subscale scores: "normal/mild"-normal function in all domains or slowing in one domain, "moderate"-slowing in ≥2 domains or missing function in one domain, and "severe"-missing function in ≥2 domains or slowing in ≥1 plus missing in one domain. PEDI and PedsQL both differed significantly across the severity groups. PSOM-SCS displayed high concordance with mRS (agreement coefficient [AC2] = 0.88) and KOSCHI (AC2 = 0.79). The PSOM-SCS constitutes a valid tool for classifying overall neurological severity emphasizing function and encompassing the full range of severity in pediatric stroke. Arithmetic summing of the PSOM subscales scores to assess severity classification is inadequate.The prior severity classification using PSOM overestimates poor outcomes.Three distinct severity profiles using PSOM subscales are identified.The PSOM-SCS is in moderate to excellent agreement with other disability measures.PSOM-SCS offers a valid tool for classifying the overall neurological deficit severity.

Designing a Multi-Stakeholder Collaboration to Reduce Overuse of Neuroimaging for Minor Head Injury and Atraumatic Headache

Despite recommendations to limit the use of neuroimaging for evaluation of minor head injury and atraumatic headache in children, many children receive unnecessary imaging without clear history or physical exam indications in the emergency department (ED) or other outpatient settings. This overuse of neuroimaging has not previously been explored across clinical settings, nor for the diagnosis of atraumatic headache.We convened a multi-stakeholder design meeting to discuss reasons for overuse of neuroimaging in children and brainstorm potential interventions to reduce overuse. The meeting included didactic sessions on the risks and benefits of neuroimaging and quality improvement methodology. There were also small group discussions of challenges and potential interventions.Participants included ED physicians and nurses, radiologists, Medicaid health plan representatives, a pediatric neurologist, a pediatric primary care provider and a parent. Reasons for overuse included family anxiety and expectations for neuroimaging, pediatric phone triage protocols directing patients to the ED for evaluation, time pressures within primary care and the ED clinics, and reluctance among payers to institute prior authorization for ED-based imaging studies. Several potential interventions were identified and organized into three key driver diagrams: one each for primary care, the ED, and Medicaid health plans.Convening a multi-stakeholder meeting was feasible and resulted in the identification of common reasons for overuse of neuroimaging in children and many potential interventions across clinical settings. Similar multidisciplinary approaches may be helpful for others interested in reducing the overuse of imaging in children.Discussions from a multi-stakeholder meeting with representation from primary care, pediatric emergency departments, and Medicaid health plans resulted in the identification of common reasons for overuse of neuroimaging in children and many potential interventions across clinical settings.

Guideline adherence in the management of head injury in Australian children: A population-based sample survey.

Head injuries in children are a common and potentially devastating presentation. The CareTrack Kids (CTK) study assessed care of Australian children aged 0-15 years, in 2012 and 2013, to evaluate the proportion in line with guideline-based indicators for 17 common conditions. Overall adherence to guideline-based recommended practice occurred 59.8% of care encounters (95% CI: 57.5-62.0), and 78.3% (95% CI: 75.1-81.2) for head injury. This paper presents results for head injury, at indicator level. A modified version of the RAND-UCLA method of indicator development was used. Indicators, measurable components of a standard or guideline, were developed from international and national guidelines relating to head injury in children and were ratified by clinical experts using a Delphi process. Paediatric nurses extracted data from medical records from general practitioners (GPs), emergency departments (EDs) and inpatient wards in Queensland, New South Wales and South Australia, for children under 15 years receiving care in 2012-13. Our purpose was to estimate the percentage adherent for each indicator. The medical records of 629 children with head injury were examined. Fifty-one percent of children were under 5 years old, with more males (61%) than females. Thirty-eight indicators were assessed. Avoidance of nasotracheal airways (100%; 95% CI: 99.4-100) or nasogastric tubes (99.7%; 95% CI: 98.5-100) for children with a head injury had the highest adherence. Indicators relating to primary and secondary assessment of head injuries were mostly adhered to. However, adherence to other indicators was poor (e.g., documentation of the past history of children (e.g., presence or absence of seizures) before the injury; 29.9% (95% CI: 24.5-35.7)), and for others was difficult to estimate with confidence due to small sample sizes (e.g., Children with a head injury who were intubated had PaO2 above 80mm Hg; 56.0% (95% CI: 28.6-80.9)). Indicators guiding clinical decision making regarding the need for CT scan had insufficient data to justify reporting. This study highlights that management of head injury in children mostly follows guidelines, but also flags some specific areas of inconsistency. Individual sites are encouraged to use these results to guide investigation of local practices and inform quality improvement endeavours.

転落・墜落による小児の頭部外傷に関する検討(Clinical characteristics of fall–related head injuries in children)

要旨 【目的】小児では転落・墜落による外傷が多くみられ，このうち頭部外傷の割合が多いとされているが，これらを詳細に検討した報告は少ない。今回我々は，当院に救急搬送された小児の転落・墜落による頭部外傷の臨床的特徴を検討したので報告する。【対象】2009年1月1日から2016年12月31日までに当院に救急搬送された15歳以下の転落・墜落外傷224例を後方視的に検討した。【結果】全224例中，不慮の事故による受傷が218例，自傷行為によるものが6例であった。転落・墜落の受傷機転は，椅子や階段からの落下が最も多く（59例），以下，遊具からの落下（34例），両親などに抱かれた状態からの落下（27例），建築物からの落下（25例），木や岩などからの落下（16例），ショッピングカートからの落下（6例）となっていた。受傷部位に着目すると，全転落・墜落外傷224例中178例（79.5%）に頭部外傷がみられ，18例（8.0%）はAIS 3点以上の重症頭部外傷であった。年齢が上がるに従い，頭部外傷の発生割合は有意に低下したが，重症化の割合は低下しなかった。【結語】小児の転落・墜落外傷では，年齢とともに頭部外傷の割合が有意に低下するが，重症化の割合に一定の傾向はみられず，どの年齢でも重症化がみられた。

The Use of PECARN and CATCH Rules in Children With Minor Head Trauma Presenting to Emergency Department 24 Hours After Injury.

Major studies (PECARN [Pediatric Emergency Care Applied Research Network], CATCH [Canadian Assessment of Childhood Head Injury]) that regulate the use of computed tomography (CT) algorithms in children with minor head trauma (MHT) have been conducted among children presenting in 24 hours after injury. In this study, we aimed to compare use and results of PECARN and CATCH rules in children presenting in and after 24 hours following injury. Records of children who were admitted to emergency department and underwent CT imaging because of MHT during a 5-year period were retrospectively reviewed. Efficacy of PECARN and CATCH rules was investigated for predicting traumatic CT findings in patients presenting in and after 24 hours. Logistic regression was performed to evaluate whether presenting after 24 hours affected the ability of guidelines in predicting traumatic CT findings. This study included 2490 patients who met the criteria. Of these patients, 6.7% (168/2490) presented after 24 hours following injury. Traumatic CT findings were found in 6.7% (168/2490) of patients. This rate was 6.9% (161/2322) in those presenting in 24 hours and 4.2% (7/168) in those presenting after 24 hours, and there was no significant difference in the incidence of traumatic CT findings between the 2 groups (P = 0.17). Among children presenting in 24 hours, the sensitivity of PECARN was 96.3% (95% confidence interval [CI], 91.7%-98.5%), whereas the sensitivity of CATCH was 91.9% (95% CI, 86.3%-95.4%) in detecting traumatic intracranial injury. The sensitivity of both PECARN and CATCH was 85.7% (95% CI, 42.0%-99.2%) among children presenting after 24 hours. Presence of CT scan indication according to PECARN statistically predicted intracranial damage, and this was not affected by the admission time. Patients with MHT presenting after 24 hours following injury constitute a clinically important population. Regardless of the admission time, current guidelines predict traumatic CT abnormalities.

Closed traumatic brain injury in children

Background Accidental injuries are the most common reason for death among children. Of all the types of traumatic injuries, brain injuries are the most cause of death or permanent disability. Aim The aim of this study is to evaluate posttraumatic hospital-admitted children to reach better management, outcome, and prognosis and to achieve the best possible care for closed-head injury patients. Patients and methods This prospective study (May 2018–May 2019), conducted at Luxor International Hospital and Al-Azhar University Hospital, includes all children aged 0–14 years with exclusion of children older than 14 years and penetrating head injuries. All the case records were reviewed and the pertinent data (clinical history, age, sex, mode of injury) were analyzed. We categorized them into mild, moderate, and severe head injuries based on the Glasgow coma scale (GCS) at the time of admission. Results Out of 30 children with traumatic brain injury (TBI), 17 (56.7%) were of mild, nine (30%) moderate, and four (13.3%) severe TBI. In the group of patients in the category of GCS less than or equal to 8, poor outcome was seen in 50%, followed by patients in group GCS 9–12 at 0%, succeeded by group of patients with GCS 13–15 at 0%, which was statistically significant. Conclusion This study has shown that the reason for TBI in children we managed was age dependent. Falls were widespread in toddlers, pedestrian accidents more common in preschool and school-age groups. This study has shown that the outcome of head injury in children we managed depended on the severity of the injury.

An Unusual Case of Penetrating Injury Skull with Metallic RCC Rod in A Child – A Rare Case Scenario with Review of Literature

Penetrating head injuries can be the result of numerous intentional or unintentional events, including missile wounds, stab wounds, and motor vehicle or occupational accidents (nails, screw-drivers). Penetrating head injuries in children constitute even a smaller part of the total number of traumatic head injuries seen in casualty. We report a case of neuro-trauma who was operated in our institution. A 6-year-old female presented in casualty with an iron rod penetrating into the skull.