Traumatic Head Injury In Children Research Articles

Outcome of Severe Traumatic Head Injury in Children

Objective: The purpose of this study was to report on the result and complications of titanium mesh cranioplasty in patients with trauma. Materials and Methods: The patients who underwent craniectomy previously for acute subdural hematomas (20 cases) or depressed fractures (40 cases) following RTA (road traffic accidents) were included in the study. Titanium mesh was placed on the skull defect 3 – 6 months later in the private hospitals of Quetta. The resulting complications were reported. Results: There were 50 male and 10 female patients. The majority (66.66%) of patients were from the age group 15 – 40 years. The majority of patients (83.33%) did not develop any complications. 8.3% of patients had wound infections, 3.3%had mesh exposures, 1.6% developed loosening screws and 1.6% had mesh indentation due to external pressure. Conclusion: This study concludes that there are few patients (< 20%) who develop complications after cranioplasty. The study’s findings will assist neurosurgeons in the clinical decision-making process. Keywords: Titanium Mesh Cranioplasty, Acute Subdural Hematoma, Road Traffic Accident, Depressed Fractures.

Head Trauma in Children: An Epidemiological Study

Introduction: Brain injury is one of the most common causes of death among victims of trauma in various accidents. The type of accident and outcome could be different in children from adults. Therefore, we aimed to investigate the epidemiology of traumatic head injury in children. Materials and Methods: In this cross-sectional study, 114 patients (age≤15 years) with head trauma, who were admitted to trauma ward of Imam Reza hospital in 2018 were enrolled in the study. Data regarding the demographic characteristics, mechanism of trauma, season of trauma, hemodynamic findings and outcome of the patients were collected. Results: The mean age amongst victims of trauma was 6.52±3.95 years and majority of them (70.2%) were male. Most of traumatic accidents took place in the spring (27.2%) and summer (32.5%). Traffic accidents (pedestrians or passenger) (55.3%) and falling (39.5%) were the most common mechanism of trauma. Also, epidural hematoma (EDH) and brain contusion were the most encountered type of brain injury (1.75%). Nine patients (7.89%) underwent brain surgery. Eventually, eight patients (7.17%) died. Conclusion: Falling and vehicle accidents are the main causes of head injury among children. Increasing the parents’ awareness toward these types of accidents and proper preventive measures can reduce traumatic brain injury.

Effectiveness of Educational Nursing Strategies on Nurse’s Knowledge and Skills regarding Traumatic Head Injury in Children

Traumatic head injury is a pressing public health problem leading to disability and death in children and adolescents worldwide. Aim : This study aimed to assess the effectiveness of educational nursing strategies on nurse’s knowledge and skills regarding traumatic head injury in children. Setting : The study was conducted in the Paediatric Intensive Care Unit and Emergency Department at Birket El Sabah Central Hospital, Menoufia Governorate, Egypt. Methods : A quasi-experimental design was carried out for this study (pre/post & follow-up). A convenience sample of 40 nurses provided direct nursing care to the children with traumatic head injury in the above-mentioned setting was selected from February to October 2019. Two tools were used for data collection, tool one: A structured interviewing questionnaires, it consisted of 7 sections to assess nurses' knowledge. Tool two: An observational checklist to assess the nurses’ practice of the Glasgow coma scale. Results : The results of this study revealed that there was a high statistical significance difference between pre, post and follow up tests regarding nurses’ knowledge and skills of children with traumatic brain injury at 1% level of statistical significance. Conclusion , Implementation of educational nursing strategies improved nurses' knowledge and skills while managing children with traumatic head injury. Recommendation , Continuous educational programs should be scheduled on a constant base for nurses' about traumatic brain injury to enhance children’s quality of care and improve their outcome. Keywords: Educational nursing strategies , Nurses , Knowledge, Skills, Children, Traumatic head injury DOI : 10.7176/JHMN/69-12 Publication date: December 31 st 2019

Clinico-etiological profile and outcome of traumatic head injury in children- a tertiary care experience

Introduction: Children are most vulnerable to head injury, which is one of the most common indications for hospitalization and is often associated with significant morbidity and mortality in severe cases. This study was undertaken to know about the clinical profile, etiology and outcome of head injury in children in a tertiary care hospital. Study Design: Retrospective study. Materials and method: This study was done on 53 children with head injury admitted to pediatric department of Velammal Medical College, Madurai from October 2013- December 2016. Results: Out of the 53 children studied with head injury, males outnumbered (60.3%) females (39.6%). Road traffic accident was the most common cause of head injury (52.8%), followed by accidental fall (47.1%). Vomiting was the most common symptom at admission (58.4%) followed by injuries to scalp and face (41.5%) headache (37.7%), altered sensorium (28.3%). Head injury was mild in severity in 71.6% of childer. Neuro-imaging analysis showed traumatic brain injury in (73.5%) of them, skull bone fractures in (49%), facial bone fractures in (15%) of children. Outcome was measured as with full recovery in 86.7% of children, (5.6%) had partial recovery, death in 3.7% of children. Conclusion: Parental guidance is advised to avoid accidental falls. Implementation of strict traffic rules, timely intervention and aggressive management reduces morbidity and mortality in children with traumatic head injury.

Biofidelic neck influences head kinematics of parietal and occipital impacts following short falls in infants

Falls are a major cause of traumatic head injury in children. Understanding head kinematics during low height falls is essential for evaluating injury risk and designing mitigating strategies. Typically, these measurements are made with commercial anthropomorphic infant surrogates, but these surrogates are designed based on adult biomechanical data. In this study, we improve upon the state-of-the-art anthropomorphic testing devices by incorporating new infant cadaver neck bending and tensile data. We then measure head kinematics following head-first falls onto 4 impact surfaces from 3 fall heights with occipital and parietal head impact locations. The biofidelic skull compliance and neck properties of the improved infant surrogate significantly influenced the measured kinematic loads, decreasing the measured impact force and peak angular accelerations, lowering the expected injury risk. Occipital and parietal impacts exhibited distinct kinematic responses in primary head rotation direction and the magnitude of the rotational velocities and accelerations, with larger angular velocities as the head rebounded after occipital impacts. Further evaluations of injury risk due to short falls should take into account the impact surface and head impact location, in addition to the fall height.

PP10.8 – 2503: Sinus sagittalis superior thrombosis complicating moderate traumatic head injury in a child

Objective Posttraumatic dural sinus thrombosis is a rare complication of traumatic head injury in children. Before the new anticoagulation guidelines (AHA/ASA 2011) the majority of patients were conservatively managed and their recoveries were mostly uneventful. However there are a few case reports where severe complications and even death occurred. According to the new guidelines pharmacological treatment of posttraumatic dural sinovenous thrombosis consists of administering low molecular weight heparin, (LMWH) or venous heparin. In situations, where systemic anticoagulation is contraindicated, local thrombolysis is allowed. Case report A 14 year old child suffered moderate traumatic head injury. Subgaleal and epidural hematomas were diagnosed on CT, and the suspicion of superior sagittal sinus thrombosis was raised. MR venography verified an incomplete superior sagittal sinus (SSS) thrombosis. Weighting the risk of progression of the thrombosis to further bleeding full dose LMWH was administered. Results The patient remained stable, but the hematomas started to grow. Neuroradiological counselling revealed suturolysis of the corona sutures on both sides, and fracture of the inner table of the skull at the sagittal superior suture on CT. A small epidural hematoma over the superior sagittal sinus was diagnosed, compressing the vein. The dose of LMWH was lowered to preventive dosage, and was administered for four month. On the follow up MRI examination the hematomas were absorbed, and the SSS recanalised. Conclusion Treating traumatic sinodural thrombosis in children with intra and extra cranial hematomas remains controversial. The decision in these situations must be individualized and during the clinical course frequently re-evaluated

Burden of traumatic injuries in Saudi Arabia: lessons from a major trauma registry in Riyadh, Saudi Arabia.

BACKGROUND AND OBJECTIVESIn Saudi Arabia (SA), injuries are the second leading cause of death; however, little is known about their frequencies and outcomes. Trauma registries play a major role in measuring the burden on population health. This study aims to describe the population of the only hospital-based trauma registry in the country and highlight challenges and potential opportunities to improve trauma data collection and research in SA.DESIGN AND SETTINGSUsing data between 2001 and 2010, this retrospective study included patients from a large trauma center in Riyadh, SA.PATIENTS AND METHODSA staff nurse utilized a structured checklist to gather information on patients’ demographic, physiologic, anatomic, and outcome variables. Basic descriptive statistics by age group (≤14 vs >14 years) were calculated, and differences were assessed using student t and chi-square tests. In addition, the mechanism of injury and the frequency of missing data were evaluated.RESULTS10 847 patients from the trauma registry were included. Over 9% of all patients died either before or after being treated at the hospital. Patients who were older than 14 years of age (more likely to be male) sustained traffic-related injuries and died in the hospital as compared to patients who were younger than or equal to years of age. Deceased patients were severely injured as measured by injury severity score and Glasgow Coma Scale (P<.001). Overall, the most frequent type of injury was related to traffic (52.0%), followed by falls (23.4%). Missing values were mostly prevalent in traffic-related variables, such as seatbelt use (70.2%).CONCLUSIONThis registry is a key step toward addressing the burden of injuries in SA. Improved injury classification using the International Classification of Disease-external cause codes may improve the quality of the registry and allow comparison with other populations. Most importantly, injury prevention in SA requires further investment in data collection and research to improve outcomes.

Epidemiology of traumatic head injury in children and adolescents in a major trauma center in Saudi Arabia: implications for injury prevention

BACKGROUND AND OBJECTIVESInjury to the head is the most common affected body part in pediatric trauma and could be associated with deleterious consequences. It presents a challenge for developing countries since many injuries are preventable and there are few epidemiological data to support injury prevention programs. The current study aimed to determine demographic characteristics, etiology and outcome of head injury in the pediatric population and compare findings to international figures.DESIGN AND SETINGSRetrospective review of consecutive cases registered in major trauma center database, Riyadh, from 2001 to 2009.PATIENTS AND METHODSThe database registry was limited to hospitalized patients following injury. Any head injury in a patient ≤18 years was included.RESULTSOf 3796 patients identified, 1219 patients (32.1%) suffered head injury (mean age 8.6 years; males 78.4%). Children under 12 years comprised 66.3%. Motor vehicle crash (MVC) was the commonest cause (34.2%), followed by pedestrian injury (30.3%) and falls (28.4%). When stratified by age, falls (45.6%) were the most common etiology under 6 years while MVC was the leading cause in high school students (74.4%). The latter group had the lowest mean (SD) Glascow coma scale scores ( 8.58 [4.7]), highest mean injury severity scale scores (23.4 [21]), highest rate of craniotomy (7%) and highest mortality (20%).CONCLUSIONOne third of pediatric trauma requiring hospital admission suffered head injury. Preschoolers and elementary school students were mostly affected. The striking incidence of pedestrian and fall injuries call for organized national prevention programs. Additionally, more attention should be directed to reduce MVC among high school students given their comparative high rate of severe injuries and deaths following trauma.

Isolated traumatic head injury in children: Analysis of 276 observations

Background:To determine predictive factors of mortality among children after isolated traumatic brain injury.Materials and Methods:In this retrospective study, we included all consecutive children with isolated traumatic brain injury admitted to the 22-bed intensive care unit (ICU) of Habib Bourguiba University Hospital (Sfax, Tunisia). Basic demographic, clinical, biochemical, and radiological data were recorded on admission and during ICU stay.Results:There were 276 patients with 196 boys (71%) and 80 girls, with a mean age of 6.7 ± 3.8 years. The main cause of trauma was road traffic accident (58.3%). Mean Glasgow Coma Scale score was 8 ± 2, Mean Injury Severity Score (ISS) was 23.3 ± 5.9, Mean Pediatric Trauma Score (PTS) was 4.8 ± 2.3, and Mean Pediatric Risk of Mortality (PRISM) was 10.8 ± 8. A total of 259 children required mechanical ventilation. Forty-eight children (17.4%) died. Multivariate analysis showed that factors associated with a poor prognosis were PRISM > 24 (OR: 10.98), neurovegetative disorder (OR: 7.1), meningeal hemorrhage (OR: 2.74), and lesion type VI according to Marshall tomographic grading (OR: 13.26).Conclusion:In Tunisia, head injury is a frequent cause of hospital admission and is most often due to road traffic injuries. Short-term prognosis is influenced by demographic, clinical, radiological, and biochemical factors. The need to put preventive measures in place is underscored.

S-100B in Serum and Urine After Traumatic Head Injury in Children

Children with head trauma are frequently seen in many emergency units. The clinical evaluation of these patients is difficult for a number of reasons and improved diagnostic tools are needed. S-100B, a protein found in glial cells, has previously been shown to be a sensible marker for brain damage after head injury in adults, but few studies have focused on its use in children. In this study, 111 children with head trauma were included and venous blood and urine samples were taken at arrival (S1 and U1) and 6 hours later (S2 and U2). S-100B levels were analyzed. Clinical and radiologic evaluations were performed according to hospital routine. Two groups were identified- group 1: no computed tomography (CT) scan performed ora CT scan without any sign of trauma-related intracranial pathology (n = 105). Group 2: A CT scan with signs of trauma-related intracranial pathology (n = 6). In group 1, the median (inter quartile range) serum S-100B value in S1-samples was 0.111 microg/L (0.086-0.153), and in group 2, it was 0.282 microg/L (0.195-1.44) (p < 0.01). Also, S2 values significantly differed between the two groups. Urine values were, however, not significantly differing between the groups. Serum S-100B values within 6 hours after head trauma in children were significantly higher in patients with intracranial pathology compared with those without intracranial complications. Identification of these high-risk patients already in the emergency department is of major importance, and we suggest that S-100B could be a valuable diagnostic tool in addition to those used in clinical practice today.

2010 Update: Consequences of Hypothalamic–Pituitary Dysfunction Following Traumatic Brain Injury in Children

AS PEDIATRIC NURSES and parents can attest, childhood is a period of scrapes, bumps, and broken bones. Fortunately, most children pass into adulthood with few consequences of childhood mishaps. However, in some children, seemingly benign head injuries associated with traffic accidents, bicycle falls, and sports participation can result in a condition known as traumatic brain injury (TBI). TBI can result in a wide range of consequences, including physical and psychological disabilities and social deficits. This review focuses on pituitary dysfunction subsequent to TBI, a less recognized and potentially underdiagnosed complication.

CT and MR imaging of primary cerebrovascular complications in pediatric head trauma

The incidence of severe traumatic head injury in children has constantly increased over the last years. Diagnostic imaging has become an unrenounceable tool for the documentation and follow-up of intracranial lesions. The use of magnetic resonance imaging (MRI) in the early posttraumatic phase has led to a more thorough understanding of intracranial injuries. We retrospectively analyzed the cranial computed tomography (CCT) and magnetic resonance (MR)-studies of patients with traumatic head injuries for primary cerebrovascular complications. In 64 children (45 male, 19 female) with traumatic head injuries, CCT and MR examinations were available for analysis. The children's age ranged from 3 months to 15 years with a median age of 7 years. All patients had initial CCT on admission to the hospital with follow-up examinations depending on clinical state and initial imaging findings. All patients had at least one MR examination between 0 to 120 days after the trauma with a median time interval of 17 days. In five of 64 (7.8%) patients, cerebrovascular complications were found on imaging studies. Initial imaging within the first 24 h after the trauma detected a complete middle cerebral artery infarction in one patient and extensive sinus thrombosis after a complex skull fracture in another. In two patients, thrombosis of the transverse sinus appeared on MRI 4 to 6 days after the trauma. In another patient with open-skull injury, a posttraumatic aneurysm of the pericallosal artery was diagnosed on MRI 30 days after the trauma. Our study shows that, although primary cerebrovascular lesions after traumatic head injuries in children are rare, the radiologist should be aware of the characteristic injury patterns and the time appearance of imaging findings on CT and MRI.

Comparison of Accidental and Nonaccidental Traumatic Head Injury in Children on Noncontrast Computed Tomography

Comparison of Accidental and Nonaccidental Traumatic Head Injury in Children on Noncontrast Computed Tomography

Comparison of Accidental and Nonaccidental Traumatic Head Injury in Children on Noncontrast Computed Tomography

Mixed-density convexity subdural hematoma and interhemispheric subdural hematoma suggest nonaccidental head injury. The purpose of this retrospective observational study is to investigate subdural hematoma on noncontrast computed tomography in infants with nonaccidental head injury and to compare these findings in infants with accidental head trauma for whom the date of injury was known. Two blinded, independent observers retrospectively reviewed computed tomography scans with subdural hematoma performed on the day of presentation on 9 infant victims of nonaccidental head injury (mean age: 6.8 months; range: 1-25 months) and on 38 infants (mean age: 4.8 months; range: newborn to 34 months) with accidental head trauma (birth-related: 19; short fall: 17; motor vehicle accident: 2). Homogeneous hyperdense subdural hematoma was significantly more common in children with accidental head trauma (28 of 38 [74%]; nonaccidental head trauma: 3 of 9 [33%]), whereas mixed-density subdural hematoma was significantly more common in cases of nonaccidental head injury (6 of 9 [67%]; accidental head trauma: 7 of 38 [18%]). Twenty-two (79%) subdural hematomas were homogeneously hyperdense on noncontrast computed tomography performed within two days of accidental head trauma, one (4%) was homogeneous and isodense compared to brain tissue, one (4%) was homogeneous and hypodense, and four (14%) were mixed-density. There was no statistically significant difference in the proportion of interhemispheric subdural hematoma, epidural hematoma, calvarial fracture, brain contusion, or subarachnoid hemorrhage. Homogeneous hyperdense subdural hematoma is more frequent in cases of accidental head trauma; mixed-density subdural hematoma is more frequent in cases of nonaccidental head injury but may be observed within 48 hours of accidental head trauma. Interhemispheric subdural hematoma is not specific for inflicted head injury.

Comparison of Accidental and Nonaccidental Traumatic Head Injury in Children on Noncontrast Computed Tomography

Study Objectives: Mixed-density subdural hematoma (SDH), perifalcine hemorrhage, and retinal hemorrhage are suggestive of inflicted, nonaccidental head trauma (NAHT). The purpose of this study is to compare SDH in infants with NAHT and infants with accidental head injury (AHI) for whom the date of injury was corroborated. The study examined 1) findings on noncontrast tomography (NCCT) and 2) incidence of concomitant retinal hemorrhages (RH). The results of these findings were compared between NAHT and AHI.

Cerebellar atrophy after severe traumatic head injury in children.

The purpose of this study was to describe late neuropathological MRI findings in pediatric severe head injury and to explore the relationship between these lesions and cognitive sequelae. Thirteen infants with severe head trauma (Glasgow 6) were included in this investigation. Clinical examination, a battery of tests designed to assess neurophysiological status, and MRI investigations of the brain were obtained in periods ranging between 8 and 20 months after the accident. Hemosiderin deposits, encephalomalacia, and cerebellar atrophy were the most frequent traumatic sequelae. The lesions were located in frontal lobes, the basal ganglia, and the cerebellum. Six patients had cerebellar atrophy associated with frontal or temporal postraumatic lesions. Cerebellar clinical dysfunction was observed in only 3 of these patients. Performance on tests evaluating frontal lobe functions was depressed in 5 of them. Late MRI after severe head trauma in our pediatric population showed unexpected cerebellar atrophy. Its correlation with prefrontal dysfunction is difficult to confirm because of its association with other parenchymal post-traumatic lesions. Further research involving a larger sample of patients with brain injury of varying severity is in progress, to investigate whether cerebellar atrophy could be a consequence of severe head trauma.

Novel Learning Abilities After Traumatic Head Injury in Children

The cognitive abilities of 69 children with traumatic head injury (THI) were evaluated with the California Verbal Learning Test-Children's Version (CVLT-C; Delis, Kramer, Kaplan, & Ober, 1994), the Children's Category Test (CCT; Boll, 1993), and the Wechsler Intelligence Scale for Children-Third Edition (WISC-III; Wechsler, 1991). Compared to children with mild to moderate injuries, children with severe THI demonstrated statistically significant impairments on the CVLT-C Total T-score as well as the WISC-III Processing Speed index, but findings for the CCT were less robust. Longer length of coma and male gender were associated with relatively poorer performance on the CVLT-C. Children with severe THI demonstrated difficulties with both capacity and speed of information processing, which could not be accounted for by attentional or general verbal knowledge factors. It is concluded that the combination of the CVLT-C and the WISC-III is useful in the evaluation of cognitive sequelae of THI but that findings from the CCT must be considered with some caution in this population.

Novel Learning Abilities After Traumatic Head Injury in Children

The cognitive abilities of 69 children with traumatic head injury (THI) were evaluated with the California Verbal Learning Test-Children's Version (CVLT-C; Delis, Kramer, Kaplan, & Ober, 1994), the Children's Category Test (CCT; Boll, 1993), and the Wechsler Intelligence Scale for Children-Third Edition (WISC-III; Wechsler, 1991). Compared to children with mild to moderate injuries, children with severe THI demonstrated statistically significant impairments on the CVLT-C Total T-score as well as the WISC-III Processing Speed index, but findings for the CCT were less robust. Longer length of coma and male gender were associated with relatively poorer performance on the CVLT-C. Children with severe THI demonstrated difficulties with both capacity and speed of information processing, which could not be accounted for by attentional or general verbal knowledge factors. It is concluded that the combination of the CVLT-C and the WISC-III is useful in the evaluation of cognitive sequelae of THI but that findings from the CCT must be considered with some caution in this population.

Traumatic Head Injury in Children

This book provides an in-depth analysis of past, present, and future clinical trials and research of issues involving a serious public health problem, traumatic head injury in children—a killer of children. The first part of the book describes "The Issues" (part 1) and "The Data" (part 2) in detail. These complex topics are difficult to read. Chapter 7, devoted to the University of California, Los Angeles, Study of Mild Head Injury, is exceptional. Part 3 discusses issues in life span effects, rehabilitation, and treatment. Current practice can at some point maximize aspects of therapy, such as intracranial pressure control. Many possible methods are listed and briefly described, and proposals for more clinical trials of children are made. The challenge of assessing and improving therapy in the long-term recovery phase after head injury is well described. This is an important part of the book, because it leads to the observation that

WISC-III Factor index score patterns after traumatic head injury in children

Four subtypes of Wechsler Intelligence Scale for Children-Third Edition (WISC-III) factor index score patterns were identified by means of two-stage cluster analysis in a sample of 153 children with traumatic head injury (THI). Three of these subtypes were differentiated primarily by level of performance, and bore close resemblance to clusters known to be prevalent in the WISC-III standardization sample. One subtype displayed an uncommon pattern of performance, characterized by selective impairment on the Perceptual Organization and Processing Speed factor indexes, which may be clinically significant in children with THI. Support for the reliability and validity of the subtypes is provided. It is concluded that the WISC-III is a useful tool in the evaluation of sequelae of THI in children.