Head Injury Depth as an Indicator of Causes and Mechanisms

Background:Traumatic head injury is a common cause of mortality and acquired disability in infants and children. However, patterns and outcome of head injury in infants are different from other age groups.Aims and Objectives:Aim of our study was to find out epidemiological factors, characteristics of injury, and outcome in infants with traumatic brain injury.Materials and Methods:This is a retrospective study from March 2009 through Feb 2012, at JPNATC, AIIMS, New Delhi. The clinical records of all patients, admitted with head injury were evaluated. Twenty-nine infants with traumatic brain injury were followed up and outcome was analyzed.Results:Twenty-nine infants with traumatic brain injury were included in the study. Of these 17 (59%) were boys and 12 (41%) were girls. Fall from height was recorded in 27 (93%) patients and road traffic accident was the mode of injury in 2 (7%). Mild head injury (GCS 14-15) was found in 18 (62%) patients, moderate in 4 (14%) patients (GCS 9-13), severe (GCS 3-8) in 7 (24%) patients. SDH was the most common injury in 8 (27%) patients. Out of these 4 (14%) were immediately operated, 25 (86%) were managed conservatively. Overall mortality was 11% (3 patients). Glasgow Outcome Scale was 5 in 20 (69%) patients and 3 (10.3%) patients each had GOS 3 or 4.Conclusion:Infants suffered significant brain injury due to fall. Traumatic brain injury in infants generally carries good outcome. Severe head injury was observed to be a predictor of poor outcome.

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“…Impaired consciousness and seizures are common presenting symptoms in traumatic brain injury, as described in the literature. [9161718]…”

Section: Discussionmentioning

confidence: 99%

Outcome of patients with traumatic head injury in infants: An institutional experience at level 1 trauma center

et al. 2013

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“…Many studies on pediatric head injury have confirmed a male preponderance (18)(19) . The higher incidence in males could reflect the differences in behavior between boys and girls as well as differences in exposure to hazards (20) . About 42% of our patients were in the (2-5 years) age group, resembling the largest age group in current study, which in keep with many previous studies (19,21) .…”

Section: Discussionmentioning

confidence: 99%

Accidental Head Injuries in Children: Experience of Suez Canal Teaching Hospital

Mohamed

2017

Suez Canal University Medical Journal

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Background: Accidental head injuries in children represent a significant public health problem. However, there is a paucity of data regarding rates, modes and age-related risks of these injuries especially in developing countries. Aim: To define the etiology, clinical aspects, interventions, and the clinical outcome of accidental head injuries in children presented to Suez Canal teaching hospital. Patients and Methods: Prospective analysis was conducted on children admitted to emergency department/Suez Canal teaching hospital for treatment of accidental head injuries. Data included patient`s demographics, etiology & mechanism of injury, severity of injury using pediatric Glasgow coma scale, clinical aspects, treatment received, and the final functional outcome using King's Outcome Scale for Childhood Head Injury. Results: Two hundred and six injured children aged 18 years or less were admitted to hospital in the period from January 2014 to June 2015. Male/Female ratio was 1.3/1. Falls were the commonest mode of injury (61%), followed by Road traffic accidents (18%), and home injuries (14%). Most injuries were of mild severity (83%). CT brain revealed skull fracture in 11%, and intracranial bleeds in 7%. Fourteen patients were operated upon. The mean length of hospital stay was 4.3 days. Final assessment revealed good recovery in 89% of children, moderate to severe disability in 8.5%, and a mortality rate of 2.4%. Conclusion: Children aged 2-5 years were more frequently present with an accidental head injury. Most injuries were mild, and falls were the commonest mode of injury. Most children required simple management without need for surgical intervention. Good recovery was the rule in most children with low disability and mortality rates.

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“…56 Parenchymal injuries, particularly if diffuse and/or subcortical, are associated with poor neurological and behavioral outcomes. 52,56,57 This is of particular interest as subcortical injuries (cerebral edema, hypoxic-ischemic injuries, brain shifting, or herniation) are more frequently seen in abused infants (OR, 35.6; p < 0.001). 57 Cerebral edema and parenchymal hypodensities, likely hypoxic-ischemia in nature, can be apparent on CT scans within the first 24 hours following injury.…”

Section: Parenchymal Injuries and Neurodevelopmental Outcomesmentioning

confidence: 99%

“…52,56,57 This is of particular interest as subcortical injuries (cerebral edema, hypoxic-ischemic injuries, brain shifting, or herniation) are more frequently seen in abused infants (OR, 35.6; p < 0.001). 57 Cerebral edema and parenchymal hypodensities, likely hypoxic-ischemia in nature, can be apparent on CT scans within the first 24 hours following injury. 26 MRI more readily detects parenchymal contusions, ischemic injury, and shear injuries, which may be missed by CT. 52,58 Early MRI done 24 to 48 hours after the initial trauma may identify children at risk for poor neurodevelopmental outcomes who were not identified by early CT. 52 Diffusion-weighted imaging in combination with apparent diffusion coefficient mapping is superior to conventional MRI at identification of hypoxic-ischemic injury and white matter injury.…”

Section: Parenchymal Injuries and Neurodevelopmental Outcomesmentioning

confidence: 99%

The Role of Neuroimaging in the Evaluation of Abusive Head Trauma

Hinds

Shalaby‐Rana

2016

J Pediatr Neuroradiol

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Neuroimaging is an integral part of the work-up for children who may have experienced abusive head trauma (AHT). The initial exam is usually a head computed tomography (CT), which may be followed by magnetic resonance imaging (MRI) of the brain and/or spine, depending on clinical presentation and/or findings on head CT. Neuroimaging is important for both clinical care and prognosis, as well as the process of distinguishing AHT from accidental trauma. Brain CT and conventional MRI may provide evidence of more than one traumatic event. Diffusion-weighted and susceptibility-weighted imaging help with both acute clinical interventions and prognostication about neurodevelopmental outcomes. With more widespread use of spinal MRI, there is increased appreciation of the spectrum of clinically occult spinal soft tissue injuries associated with AHT. This review highlights clinical and radiologic findings in children evaluated for AHT and emphasizes the importance of a multidisciplinary evaluation.

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Head Injury Depth as an Indicator of Causes and Mechanisms

Abstract: For children <3 years of age, head injury depth is a useful indicator of injury causes and mechanisms.

Cited by 19 publications

References 23 publications

Outcome of patients with traumatic head injury in infants: An institutional experience at level 1 trauma center

Outcome of patients with traumatic head injury in infants: An institutional experience at level 1 trauma center

Accidental Head Injuries in Children: Experience of Suez Canal Teaching Hospital

The Role of Neuroimaging in the Evaluation of Abusive Head Trauma

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