Head Injury In Young Children Research Articles

Artificial intelligence in paediatric head trauma: enhancing diagnostic accuracy for skull fractures and brain haemorrhages.

Pediatric head trauma is a significant cause of morbidity and mortality, with children, particularly those under two years old, being more susceptible to skull fractures due to their unique physiological and developmental characteristics. A recent study by Azusa Ono et al. examined the impact of repeated imaging in children under 24 months with minor head trauma, revealing that 40.6% of those who underwent follow-up MRI after an initial CT scan showed new intracranial findings. The study emphasizes the importance of careful consideration of repeated imaging based on initial findings and associated risk factors, such as the presence of subcutaneous hematoma and fractures intersecting coronal sutures. This underscores the need for improved diagnostic approaches to minimize radiation exposure while ensuring accurate diagnosis.Artificial Intelligence (AI) offers a promising solution, with research indicating that AI models can significantly improve diagnostic precision, increasing accuracy from 78.1 to 85.2% and reducing errors by two to three times. Additionally, AI has demonstrated high accuracy in detecting various types of brain hemorrhages, potentially facilitating earlier and more precise detection of hematomas associated with skull fractures. Integrating AI into diagnostic practices could enhance early detection, reduce diagnostic errors, and improve outcomes for pediatric head trauma cases. The study underscores the critical need for advanced diagnostic methods to better manage and treat head injuries in young children, where timely and accurate diagnosis is crucial.

Trends in shaken baby syndrome diagnosis codes among young children hospitalized for abuse

ObjectiveTo investigate national trends of SBS diagnosis codes and how trends varied among patient and hospital characteristics.MethodsWe examined possible SBS, confirmed SBS, and non-SBS abuse diagnosis codes among children age three and younger who were hospitalized for abuse between 1998 and 2014 using a secondary analysis of the National Inpatient Sample, the largest US all-payer inpatient care database (N = 66,854). A baseline category logit model was used based on a quasi-likelihood approach (QIC) with an independent working correlation structure.ResultsThe rate (per 100,000 census population of children age 3 and younger) of confirmed and possible SBS diagnosis codes was 5.4 (± 0.3) between 1998 and 2014, whereas the rate of non-SBS abuse was 19.6 (± 1.0). The rate of confirmed SBS diagnosis codes increased from 3.8 (± 0.3) in 1998 to 5.1 (± 0.9) in 2005, and decreased to 1.3 (± 0.2) in 2014. Possible SBS diagnosis codes were 0.6 (± 0.2) in 1998, increasing to 2.4 (± 0.4) in 2014. Confirmed SBS diagnosis codes have declined since 2002, while possible SBS diagnosis codes have increased. All abuse types were more frequent among infants, males, children from low-income homes, and urban teaching hospitals.ConclusionsWe investigated seventeen-year trends of SBS diagnosis codes among young children hospitalized for abuse. The discrepancy between trends in possible and confirmed SBS diagnosis codes suggests differences in norms for utilizing SBS diagnosis codes, which has implications for which hospital admissions are coded as AHT. Future research should investigate processes for using SBS diagnosis codes and whether all codes associated with abusive head injuries in young children are classified as AHT. Our findings also highlight the relativity defining and applying SBS diagnosis codes to children admitted to the hospital for shaking injuries. Medical professionals find utility in using SBS diagnosis codes, though may be more apt to apply codes related to possible SBS diagnosis codes in children presenting with abusive head injuries. Clarifying norms for SBS diagnosis codes and refining definitions for AHT diagnosis will ensure that young children presenting with, and coded for, abusive head injuries are included in overall counts of AHT based on secondary data of diagnosis codes. This baseline data, an essential component of child abuse surveillance, will enable ongoing efforts to track, prevent, and reduce child abuse.

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.

Acute post-traumatic hydrocephalus in children due to aqueductal obstruction by blood clot: a series of 6 patients.

Post-traumatic hydrocephalus following head injury is a well-known entity. Most cases occur in patients with severe head injuries, often following decompressive craniectomy. On the contrary, acute post-traumatic hydrocephalus, caused by aqueductal obstruction by a blood clot, following mild head injury is uncommon. Six patients aged between 6 and 15months presented hydrocephalus secondary to a blood clot in the aqueduct. Because of intracranial hypertension at presentation, 4 patients were urgently treated with external ventricular drains (EVDs). Post-operative course was uneventful. In 2 cases, EVDs were removed without further treatments. In 2 cases, hydrocephalus recurred. These patients were successfully treated with endoscopic third ventriculostomy. The remaining two patients developed symptoms a few days after the trauma. One, that presented hydrocephalus at imaging, was managed with a ventriculo-peritoneal shunt; the other, that presented subdural hygroma, was managed with subduro-peritoneal shunt that was removed later. All patients had complete recovery. Hydrocephalus secondary to clot in the aqueduct may rarely be the result of mild head injury in young children. Usually, prompt surgical management warrants a very good outcome. Most children may be treated without a permanent shunt, by using external drains and endoscopic third ventriculostomy.

The Swedish Agency for health technology-report about traumatic shaking: much ado about nothing?

The 2016 Swedish Agency for Health Technology Assessment and Assessment of Social Services (SBU) systematic review deals with the role of the 'triad' (subdural hematoma, retinal hemorrhages, and various forms of brain symptoms) in the medical investigation of suspected traumatic shaking. In this commentary we will not discuss the methodological shortcomings of the SBU-review but will concentrate on the effects of the review on the daily practice of protecting children and families in court procedures. In our opinion the report did not add anything to what was already known in clinical and forensic medicine. The SBU-review confirmed that shaking can cause the 'triad' and that there are other explanations for the 'triad' and its components. The report however did not provide a realistic list of these other explanations. The review reduced the discussion about inflicted head injury in young children to a discussion about the 'triad' and traumatic shaking, ignoring the fact that 'diagnosing' inflicted head injury concerns a complete clinical and forensic evaluation of all individual and combined findings, of which for example the presence of bruising or fractures, were excluded by the SBU-panel.

Increased in-hospital mortality following severe head injury in young children: results from a nationwide trauma registry.

BackgroundIn the current literature, the outcome of paediatric brain injury is controversially discussed. According to the majority of the studies, there seems to be a decreased mortality but worse recovery in paediatric, traumatic brain injury in comparison with adults. However, there is a lack of information concerning the differences in various stages of development in patients younger than 18 years. The aim of our study was to verify the in-hospital outcome of different paediatric age groups in comparison to adults with respect to the treatment strategy.MethodsWe performed a retrospective analysis of the TraumaRegister DGU® from 2002 to 2012. Inclusion criteria were an Abbreviated Injury Scale (AIS) head ≥3 points and an AIS ≤2 points of the remaining body regions. The collective was divided into different subgroups according to age (1–3, 4–6, 7–10, 11–14, 15–17) and an adult control group aged between 18 and 55 years. We descriptively analysed the endpoint rate of sepsis, multiple organ failure, and mortality. Additionally, the Glasgow Outcome Scale (GOS) at discharge was observed.ResultsOverall, 1110 children and 6491 adult control patients were included. Comparing the rate of intubation on-scene, the rate of cranial CT scans, the rate of craniotomies, and the rate and length of intensive care treatment, we could only identify minor differences between the age groups. The treatment after discharge from hospital was markedly different due to a very low rate of in-patient rehabilitation treatment in children. On one hand, the rate of systemic complications, such as sepsis and multiple organ failure increased with increasing age. On the other hand, we found a significantly increased mortality in children younger than 7 years after very (AIS head = 5) severe brain injury. The in-hospital functional outcome in survivors, according to the GOS, was beneficial for younger children in comparison to adolescents and adults.ConclusionsWe were unable to identify marked age-related differences in the therapeutic approach. Nevertheless, we were able to demonstrate marked differences of outcome. Children younger than 7 years significantly die more often due to direct impact of severe trauma. But if they survive, they seem to develop less systemic complications and profit from a better functional outcome.

Distinguishing accidental from inflicted head trauma at autopsy.

This article will discuss accidental and inflicted head injuries in infants and young children and how forensic pathologists distinguish between these types of injuries. The article begins with a consideration of the special and unique features of the anatomy and development of the child's head and neck and then relates these features to the mechanisms of traumatic brain injury and how these unique features influence the mechanisms of injury. The article very specifically notes that accidental head injuries in young children that occur in and around the home are focal head injuries in distinction to inflicted head injuries, which are diffuse brain injuries. The article discusses the mechanisms by which traumatic brain injury causes loss of consciousness and relates those mechanisms to the differences in the clinical features that occur in both accidental and inflicted head injury. The article discusses and illustrates the pathological findings in accidental head injuries consisting of the crushing head injuries and the head injuries sustained in short falls including epidural hemorrhage and focal subdural hemorrhage. The article discusses and illustrates the pathological findings that occur in inflicted head trauma, including subdural and subarachnoid hemorrhages and retinal and optic nerve sheath hemorrhages.

Growing skull fracture: two rare causes

Growing skull fractures are rare complications of head injury in young children. Till date, growing skull fractures due to an underlying arrested hydrocephalus or subdural hygroma have not been reported. We are reporting two such rare cases. A 12-year-old male who was a known case of arrested hydrocephalus sustained a mild head injury and was found to have a linear fracture. One month after the initial injury, a soft swelling was noted in the parietal region. Investigations revealed the dilated ventricular system communicating through a growing skull fracture with a subgaleal CSF collection. The patient underwent a ventriculoperitoneal shunt using a high-pressure shunt system. The patient died suddenly 48 h after the surgery. An 8-month-old female child sustained a mild head injury with a linear fracture in the parieto-occipital region. Two months later, the child presented with seizures and a soft, fluctuant swelling in the parieto-occipital region. Imaging revealed a frontoparietal subdural hygroma with mass effect that was communicating through a growing skull fracture with a subgaleal CSF collection. The patient underwent a subduroperitoneal shunt. The shunt tube was removed 3 months later as it protruded through the abdominal wound. Follow-up imaging studies revealed complete resolution of the subdural hygroma with healing of the growing skull fracture. Growing skull fractures can occur as complications of mild head injury sustained in the setting of either arrested hydrocephalus or subdural hygroma. Hence, close follow-up of patients with skull fracture and arrested hydrocephalus/subdural hygroma is necessary for early diagnosis of growing skull fractures.

Acute and chronic management of traumatic brain injury

Traumatic brain injury is recognized as the biggest cause of death and acquired disability after infancy. Its importance, especially in children, has been re-emphasized by a recent population based study, the first of its kind, which found a much higher incidence than previously reported: 790 per 100 000 person years.1 This was chiefly due to the detection of more cases of mild injury, which accounted for 95% overall. Children under 5 had the highest incidence and 70% of all cases were in children and young adults. Falls were the biggest cause, except in the 15-34 year age group where transport accidents were more frequent and injuries more likely to be moderate or severe. These data add to previous studies, especially in informing policies aimed at prevention, which are already showing benefits in many countries. However, once a child or adult has had a severe brain injury it is still uncertain how best to help them. Prompt effective resuscitation and subsequent intensive care are beneficial, but what next? Much attention has been devoted to the management of raised intracranial pressure, which occurs due to the brain swelling inside a fixed compartment (the skull) and can lead to impaired blood supply and cerebral herniation. In adults, observational studies have suggested that measurement of intracranial pressure and decompression by various different craniectomy procedures improves outcome. However, more recent controlled studies indicate that this may not be correct. The DECRA trial in Australia and New Zealand randomized 155 adults to receive bifrontotemporoparietal decompressive craniectomy, with dural opening, or standard care.2 Those in the craniectomy group had a lower intracranial pressure and duration of intensive care stay, more immediate complications especially hydrocephalus, and a poorer outcome at 6 months follow-up. Another major study in South America randomized 324 adults and adolescents to intracranial pressure assessment either by clinical and imaging criteria or by direct measurement.3 The first group received significantly more brain specific interventions such as hyperventilation, mannitol and hypertonic saline, although not more cerebrospinal fluid drainage or craniectomy, but there was no difference in mortality or other outcome measures. The DECRA trial also illustrates the difficulties of such studies: over 3000 patients were assessed for eligibility, one unit contributed over a third of the data, and it took 12 years to enrol enough patients to meet even a revised statistical threshold. The trial has been criticized from various aspects including the entry criteria.4 Another international trial, RESCUEicp, using the same surgical technique but different entry criteria in patients aged 10 to 65 years, is currently in progress.4 Finally, decompression is only one possible tool in acute management: others such as hypothermia, hyperventilation, and hyperosmolar and pharmacological agents also lack strong supportive evidence for their use.5 From a paediatric perspective, despite the high incidence of traumatic brain injury in young children, not to mention their greater life expectancy, there has been a marked paucity of any similar studies. The biggest was a pilot study published over a decade ago in 27 children aged 12 months or older admitted over a 7-year period which used a different technique, bitemporal craniectomy, and found that outcome at 6 months might be improved.6 No long-term follow-up has been published and no similar studies have been performed since.4 While it might be reasonable to await results of studies in adults, it can also be argued that a young child's brain may respond differently to injury for both anatomical and physiological reasons.4 Although the effects of acute management strategies often remain unproven, some evidence is available for adults, and to a much lesser extent for children, showing benefit from rehabilitation.5, 7 At present then in a logical world as much research should be devoted to methods of rehabilitation as to perhaps more glamorous acute interventions. Finally, the outcome of severe injury is well documented but the possible effects of mild head injuries in young children remain less clear and in view of their newly recognized high incidence this needs more work too.

Serious head injury in young children: Birth trauma versus non-accidental head injury

Birth injury of the skull and central nervous system can be a complication of a difficult delivery, especially following forceps or vacuum-assisted delivery. Birth trauma of the head can also mimic the appearance of a non-accidental head injury and is therefore an important differential diagnosis. We report on two young infants with serious head injuries. The difficult differential diagnosis birth trauma versus non-accidental head injury is discussed and the necessity for cooperation between clinicians, forensic doctors and specialized neuroradiologists is emphasized.

Mandatory reporting in the emergency department: Case study reviews of head injuries in young children

Mandatory reporting in the emergency department: Case study reviews of head injuries in young children

The Risk of Growing Skull Fractures in Craniofacial Patients

Background/Aims: Growing skull fractures (GSFs) are unusual sequelae of head injury in young children which have also been reported to occur after craniofacial procedures complicated by inadvertent durotomy. We reviewed the craniofacial experience in a single institution, detailing 180 cases of craniofacial surgery and suspected dural tears and their relationship to the subsequent development of GSFs. This experience was then compared to that of the pertinent published literature. Methods: A retrospective review of the senior authors’ craniofacial surgical experience from 2000 to 2007 was performed. This was compared to an English-language literature review of GSFs after craniofacial surgery. Results: In our institution, 180 cases of craniofacial surgery (83 open, 97 endoscopic) were performed, with an average follow-up of 23.5 months. Twenty-five patients (15 open, 10 endoscopic surgeries) had operative dural compromise. One of these patients developed a persistent pseudomeningocele requiring reoperation. Twelve cases of GSF after craniofacial surgery were identified in a review of the English-language literature, of which 7 (58%) had coronal suture fusion. Conclusions: While durotomy may occur during craniofacial surgery, the subsequent development of a GSF appears to be an unlikely event with an aggressive intraoperative approach of identification and repair. Coronal craniosynostosis may confer an increased risk for this complication.

Early head injury and attention deficit hyperactivity disorder: retrospective cohort study

. Keenan H. T., Hall G. C. & Marshall S.W. ( 2008 ) , 337 , a1984 . DOI:10.1136/bmj.a1984 . Objective To explore the hypothesis that medically attended head injury in young children may be causal in the later development of attention deficit hyperactivity disorder.Design Retrospective cohort study.Setting Health improvement network database (1988–2003), a longitudinal UK general practice dataset.Participants All children registered in the database from birth until their 10th birthday.Main outcome measures Risk of a child with a head injury before age 2 developing attention deficit hyperactivity disorder before age 10 compared with children with a burn injury before age 2 and children with neither a burn nor a head injury.Results Of the 62 088 children who comprised the cohort, 2782 (4.5%) had a head injury and 1116 (1.8%) had a burn injury. The risk of diagnosis of attention deficit hyperactivity disorder before 10 years of age after adjustment for sex, prematurity, socio‐economic status and practice identification number was similar in the head injury (relative risk 1.9, 95% confidence interval 1.5 to 2.5) and burn injury groups (1.7, 1.2 to 2.5) compared with all other children.Discussion Medically attended head injury before 2 years of age does not seem to be causal in the development of attention deficit hyperactivity disorder. Medically attended injury before 2 years of age may be a marker for subsequent diagnosis of attention deficit hyperactivity disorder.

Non accidental head injury in young children, medical, legal and social responses by Cathy Cobley and Tom Sanders, Jessica Kingsley, London, 2007. 192pp. ISBN 978‐1‐84310‐360‐8 (£19.99)

Child Abuse ReviewVolume 17, Issue 5 p. 362-363 Book Review Non accidental head injury in young children, medical, legal and social responses by Cathy Cobley and Tom Sanders, Jessica Kingsley, London, 2007. 192pp. ISBN 978-1-84310-360-8 (£19.99) Philip L. Wheeler, Philip L. Wheeler Territorial Policing Headquarters Metropolitan Police LondonSearch for more papers by this author Philip L. Wheeler, Philip L. Wheeler Territorial Policing Headquarters Metropolitan Police LondonSearch for more papers by this author First published: 29 September 2008 https://doi.org/10.1002/car.1033AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article. Volume17, Issue5September/October 2008Pages 362-363 RelatedInformation

Risk of Cervical Spine Injury and Other Complications Seen with Skull Fractures in the Setting of Mild Closed Head Injury in Young Children: A Retrospective Study

We have reviewed records for patients under 2 years of age who presented at our hospital with mild closed head injuries and nondisplaced skull fractures, specifically to examine methods utilized for spine clearance, associated cervical injuries, involvement and findings of child protective services and delayed complications. Of 42 patients included in the series, none were found to have cervical spine injuries. Child protective services were involved in 12 cases with confirmatory findings and subsequent placement occurring in 2 cases. There were no serious delayed complications in this series of patients. AP and lateral plain films of the cervical spine are nonetheless recommended until larger prospective studies suggest otherwise.

Early head injury and attention deficit hyperactivity disorder: retrospective cohort study

Objective To explore the hypothesis that medically attended head injury in young children may be causal in the later development of attention deficit hyperactivity disorder.Design Retrospective cohort study.Setting Health improvement...

Non-Accidental Head Injury in Young Children: Medical, legal and social responses Cathy Cobley Non-Accidental Head Injury in Young Children: Medical, legal and social responsesandTomSanders Jessica Kingsley1922006£19.991 84310 360 51843103605

Non-Accidental Head Injury in Young Children: Medical, legal and social responses Cathy Cobley Non-Accidental Head Injury in Young Children: Medical, legal and social responsesandTomSanders Jessica Kingsley1922006£19.991 84310 360 51843103605

Material Properties of Human Infant Skull and Suture at High Rates

Clinicians are often faced with the challenging task of distinguishing between accidental and inflicted pediatric head trauma. There is currently a disparity in the anecdotal case study literature as to what kinds of injuries can occur in children from low height falls. There is also a paucity of material property data for pediatric skull and suture at rates similar to those expected in low height falls. We tested human infant (<1 year old) cranial bone and suture from 23 calveria in three-point bending and tension, respectively, at rates ranging from 1.2-2.8 m/sec. Donor age was found to have the largest influence on the elastic modulus and ultimate stress of cranial bone, with an increase in age increasing both material properties. In adults, cranial bone and suture have similar properties and the adult calveria deforms very little prior to fracture. In contrast, pediatric cranial bone is 35 times stiffer than pediatric cranial suture. In addition, pediatric cranial suture deforms 30 times more before failure than pediatric cranial bone and 243 times more than adult cranial bone. The large strains in the pediatric bone and suture result in a skullcase that can undergo dramatic shape changes before fracture, potentially causing substantial deformation in the brain. The sizeable difference between pediatric bone and suture material properties also underscores the crucial role that sutures play in the unique response of the pediatric head to impact in low height falls. These data provide necessary information to enhance our understanding of mechanisms of head injury in young children.

19. Injuries from Shopping Carts and Strollers in the Pediatric Population

On average, nationally 24,000 children a year are treated in emergency departments for shopping cart injuries, with more than 650 children a year requiring hospital admission. Nationally, an estimated 13,000 visited emergency departments because of stroller-related injuries. This study evaluated the incidents and outcomes of children in the community evaluated by paramedics for shopping cart–related or stroller-related injuries. This study was a retrospective review of prehospital patient records for all patients younger than 14 years old who were injured in shopping cart–related and stroller-related incidents and were responded to by paramedics from July 1997–December 2000. The study occurred in a large metropolitan area. Prehospital patient records were identified for all patients younger than 14 years old. These records were searched for all patients who were injured in an incident involving a shopping cart or stroller. Descriptive analyses were performed on patient demographics, injury type, injury severity, and patient disposition. During the study period, 241 cases were identified consisting of 120 shopping cart–related and 121 stroller-related injuries. The most frequent age for stroller injuries was birth to 6 months, and for shopping cart injuries, 1 year. Falls were the most common mechanism of injury, 70.3% for shopping carts and 47.5% for strollers. Head injuries accounted for 53% and 59% of the primary injuries from shopping cart and stroller incidents, respectively. An additional 12% and 18% suffered primary facial injuries. Although the paramedics recommended transport to the emergency department for evaluation in all cases, 19% of the parents declined transport. Paramedics transported 77% of patients to an emergency department for evaluation. Of the transported patients, 8.2% were admitted to the hospital. There were no deaths. Shopping cart–related and stroller-related injuries are a common mechanism of injury among children. Most of injuries are easily preventable with use of a seat belt. More than half of the patients in this study suffered head injuries. Researchers have shown that unrecognized and mild head injuries in young children can lead to cognitive and behavioral dysfunction. Given the number of parents who declined transport for their child to the emergency department, this is an injury area that requires parent and caregiver education and concerted prevention efforts. Given that children visit emergency departments at an estimated annual rate of 36.4/100, emergency nurses have the opportunity during visits for other causes to provide education to parents on stroller and shopping cart injury prevention and the long-term effects of unrecognized and untreated mild head injury.

Accidental and abusive head injury in young children.

Children commonly present for medical care after sustaining head trauma. In children younger than 2 years of age, the practitioner must distinguish accidental head injury from abusive head injury. The following article discusses the evaluation of children with head injury and how to make the distinction between accidental and abusive head injury.