Pediatric head injury: An epidemiological study.

Dear Sir,

In India, children between 1 and 15 years form about 35% of the total population.[1] Head Injury in infancy and childhood has been documented as the single most common cause of death.[2] Moreover, the modes of injury, the mechanisms of damage, and the management of specific problems differ significantly between the adult and pediatric populations.

This study was done to analyse the epidemiology of pediatric head injury in relation to age distribution, sex, mode of injury, and types of injuries.

This study includes 200 consecutive children aged 12 or less reporting to the Neurosurgical emergency of our institute. The management was done as per department protocol. All details pertaining to the study were noted as per set proforma. It included age, sex, mode of injury, GCS at arrival and discharge, outcome, CT scan findings, clinical findings, and presence or absence of seizure. The data were tabulated and analyzed.

Amongst the 200 patients aged 12 years or less, there were 123 males and 77 females (M:F = 1.59). Infants were only 13; 105 children in the age group of 1–5 years and 82 children between 5 and 12 years. The age distribution is shown in Table 1.

Table 1

Age distribution of cases

The most common mode of injury was fall from height (unprotected rooftops while playing) seen in 56.5% of patients, followed by road traffic accident (being hit by a moving vehicle), accounting for 21% of injuries. Other modes were simple falls from chair or bed (17.5 %) and falling of heavy objects on the head. Graphic representation is shown in Figure 1. Seizure was seen in 10% of the patients.

Figure 1

Mode of injury

The most common lesion found on CT scan was an extradural hematoma, which was seen in 33 (16.5%) patients. About half of these (15) needed evacuation. Cerebral contusion was seen in 15% of the patients, the frontal lobe being the most common site. Other lesions are shown in Table 2.

Table 2

CT scan findings

Various studies on pediatric head injury have confirmed a male preponderance (59–71 % of cases).[3-6] However, Sambasivan[7] has reported an equal number of males and females in his series on pediatric head injury. Fall from height has been cited by most studies as the most common cause of pediatric head injury.[3-8] This is followed by road accidents, assaults, sports injuries, and various other mechanisms like coconut injury.[7]

Our results are in accordance showing fall from height as the most common cause of pediatric head injury. This peculiarly occurs from unguarded rooftops while the child is playing. However, Osmond[4] from Canada cites motor accidents as the most common cause. The most common lesion seen on CT scan was an EDH, whereas Mahapatra reports contusion as the most common. Seizure was seen in 10% of our patients; a similar incidence has been reported by others also.[9] Mortality was 10% and limited to patients of severe head injury only. A mortality of 20–50% has been reported for severe head injury.[6]

Falls form the most important cause of pediatric head injury and slight carefulness on the part of parents can help avoid disastrous consequences for the children.