Clinically-Important Brain Injury and CT Findings in Pediatric Mild Traumatic Brain Injuries: A Prospective Study in a Chinese Reference Hospital

Abstract

This study investigated injury patterns and the use of computed tomography (CT) among Chinese children with mild traumatic brain injury (MTBI). We enrolled children with MTBI who were treated within 24 hours of head trauma in the emergency department of Wuhan Medical Care Center for Women and Children in Wuhan, China. Characteristics of MTBIs were analyzed by age and gender. Results of cranial CT scan and clinically-important brain injury (ciTBI) for children were obtained. The definition of ciTBI was: death from TBI, intubation for more than 24 h for TBI, neurosurgery, or hospital admission of 2 nights or more. Of 455 eligible patients with MTBI, ciTBI occurred in two, and no one underwent neurosurgical intervention. CT scans were performed for 441 TBI patients (96.9%), and abnormal findings were reported for 147 patients (33.3%, 95% CI 29.0–37.8). Falls were the leading cause of MTBI (61.5%), followed by blows (18.9%) and traffic collisions (14.1%) for children in the 0–2 group and 10–14 group. For children aged between 3 and 9, the top three causes of TBI were falls, traffic collisions and blows. Leisure activity was the most reported activity when injuries occurred for all age groups. Sleeping/resting and walking ranked in the second and third place for children between 0 and 2 years of age, and walking and riding for the other two groups. The places where the majority injuries occurred were the home for the 0–2 and 3–9 years of age groups, and school for the 10–14 years of age group. There was no statistical difference between boys and girls with regard to the activity that caused the MTBI. This study highlights the important roles that parents and school administrators in the development of preventive measures to reduce the risk of traumatic brain injury in children. Also, identifying children who had a head trauma at very low risk of clinically important TBI for whom CT might be unnecessary is a priority area of research in China.

Sex and age differences in hospitalized pediatric traumatic brain injury

“…In the present study, boys outnumbered girls in pediatric TBI requiring hospitalization (male : female ratio, 1.6:1), which is consistent with previous studies on the ratio of TBI in boys and girls . The male : female ratios found by Shao et al .…”

“…In the present study, boys outnumbered girls in pediatric TBI requiring hospitalization (male : female ratio, 1.6:1), which is consistent with previous studies on the ratio of TBI in boys and girls. 17,18,20,22,23,30,31 The male : female ratios found by Shao et al and Li et al were 1.87:1 and 2.28:1, respectively. 22 The higher proportion of boys being hospitalized for TBI may be related to previous findings that boys are naturally more active and adventurous than girls.…”

Estimating the global incidence of traumatic brain injury

“…The systematic review to describe TBI epidemiology and to quantify TBI MOI yielded more than 240 full-text articles from an initial 8756 titles. [261][262][263][264][265][266][267] The search process is illustrated in detail in Fig. 3, while the full account of included articles with relevant epidemiological data is listed in Supplemental Table S2.…”

Clinical predictors of abnormal computed tomography scan in minor head trauma in children under 2 years old

“…20,21 Zhu et al showed that minor head trauma in boys is likely more common than in girls [69.2% vs. 30.8% of total mild TBIs (MTBIs) cases]. 22 A similar report from Peloso et al showed that head injury with symptoms of concussion is twice more in boys than girls. 23 Willer et al also reported the same result in which boys suffer an MTBI more likely than girls.…”

“…Unlike these findings in another study by Zhu et al, they reported that 96.9% of children with minor head trauma were evaluated with CT scan, and 33.3% had abnormal CT findings. 22 In minor head trauma, which constitutes about 90.0% of children with head trauma, the management of these patients is not easy, and there are no widely accepted, evidence-based guidelines. 2,3, [17][18][19] It is important to identify predicating factors that could predict TBI that may help us to decrease unnecessary CT Scans.…”