José Antonio Alonso-Cadenas1, Clara Ferrero García-Loygorri2, Rosa María Calderón Checa3, Isabel Durán Hidalgo4, María José Pérez García5, Sara Ruiz González6, Maria De Ceano-Vivas7, Pablo Delgado Gómez8, Miguel Antoñón Rodríguez9, Rubén Moreno Sánchez10, José Martínez Hernando11, Cristina Muñoz López12, Irene Ortiz Valentín13, Raquel Jiménez-García14. 1. Pediatric Emergency Department, Hospital Infantil Universitario Niño Jesús, Avenida de Menedez Pelayo 65, 28009, Madrid, Spain. jalonsoc@salud.madrid.org. 2. Pediatric Emergency Department, Hospital Universitario Gregorio Marañón, Madrid, Spain. 3. Pediatric Emergency Department, Hospital Universitario, 12 de Octubre, Madrid, Spain. 4. Pediatric Emergency Department, Hospital Materno-Infantil Universitario Málaga, Málaga, Spain. 5. Pediatric Emergency Department, Hospital Universitario Puerta De Hierro, Majadahonda, Spain. 6. Pediatrics Department, Hospital Universitario Severo Ochoa, Leganés, Spain. 7. Pediatric Emergency Department, Hospital Universitario La Paz, Madrid, Spain. 8. Pediatric Emergency Department, Hospital Universitario Virgen del Rocío, Seville, Spain. 9. Pediatrics Department, Hospital Universitario Río Hortega, Valladolid, Spain. 10. Pediatrics Department, Hospital Universitario del Tajo, Aranjuez, Spain. 11. Pediatric Emergency Department, Hospital UniversitarioSant Joan de Déu Barcelona, Esplugues de Llobregat, Spain. 12. Pediatrics Department, Hospital Universitario Infanta Leonor, Madrid, Spain. 13. Pediatrics Department, Hospital Universitario Virgen de La Salud, Toledo, Spain. 14. Pediatrics Department, Hospital Infantil Universitario Niño Jesús, Madrid, Spain.
Abstract
Specific knowledge of the features of minor head trauma in infants is necessary to develop appropriate preventive strategies and adjust clinical management in pediatric emergency departments (PEDs). The aim of this study is to describe the epidemiology of minor blunt head trauma in infants < 3 months who present to PEDs. We performed a prospective study of infants evaluated in any of 13 Spanish PEDs within 24 h of a minor head trauma (Glasgow Coma Scale scores of 14-15) between May 2017 and November 2020. Telephone follow-up was conducted for all patients over the 4 weeks after the initial PED visit. Of 1,150,255 visits recorded, 21,981 children (1.9%) sustained a head injury, 386 of whom (0.03%) were under 3 months old. Among the 369 patients who met the inclusion criteria (0.03%), 206 (56.3%) were male. The main causes of trauma were fall-related (298; 80.8%), either from furniture (138/298; 46.3%), strollers (92/298; 30.9%), or a caregiver's arms (61/298; 20.5%). Most infants were asymptomatic (317; 85.9%) and showed no signs of injury on physical exam (210; 56.9%). Imaging studies were performed in 195 patients (52.8%): 37 (10.0%) underwent computed tomography (CT) scan, 162 (43.9%) X-ray, and 22 (6.0%) ultrasound. A clinically important traumatic brain injury (ciTBI) occurred in 1 infant (0.3% overall; 95% CI, 0-1.5), TBI was evidenced on CT scan in 12 (3.3% overall; 95% CI, 1.7-5.7), and 20 infants had an isolated skull fracture (5.5% overall; 95% CI, 3.4-8.3). All outcomes were caused by falls onto hard surfaces. CONCLUSION: Most head injuries in infants younger than 3 months are benign, and the rate of ciTBI is low. Prevention strategies should focus on falls onto hard surfaces from furniture, strollers, and caregivers' arms. Optimizing imaging studies should be a priority in this population. WHAT IS KNOWN: • Infants younger than 3 months are vulnerable to minor blunt head trauma due to their age and to difficulties in assessing the subtle symptoms and minimal physical findings detected on examination. • A low threshold for CT scan is recommended in this population. WHAT IS NEW: • Most cases of blunt head trauma in infants younger than 3 months have good outcomes, and the rate of clinically important traumatic brain injury is low. • Optimizing imaging studies should be a priority in this population, avoiding X-ray examinations and reducing unnecessary CT scans.
Specific knowledge of the features of minor head trauma in infants is necessary to develop appropriate preventive strategies and adjust clinical management in pediatric emergency departments (PEDs). The aim of this study is to describe the epidemiology of minor blunt head trauma in infants < 3 months who present to PEDs. We performed a prospective study of infants evaluated in any of 13 Spanish PEDs within 24 h of a minor head trauma (Glasgow Coma Scale scores of 14-15) between May 2017 and November 2020. Telephone follow-up was conducted for all patients over the 4 weeks after the initial PED visit. Of 1,150,255 visits recorded, 21,981 children (1.9%) sustained a head injury, 386 of whom (0.03%) were under 3 months old. Among the 369 patients who met the inclusion criteria (0.03%), 206 (56.3%) were male. The main causes of trauma were fall-related (298; 80.8%), either from furniture (138/298; 46.3%), strollers (92/298; 30.9%), or a caregiver's arms (61/298; 20.5%). Most infants were asymptomatic (317; 85.9%) and showed no signs of injury on physical exam (210; 56.9%). Imaging studies were performed in 195 patients (52.8%): 37 (10.0%) underwent computed tomography (CT) scan, 162 (43.9%) X-ray, and 22 (6.0%) ultrasound. A clinically important traumatic brain injury (ciTBI) occurred in 1 infant (0.3% overall; 95% CI, 0-1.5), TBI was evidenced on CT scan in 12 (3.3% overall; 95% CI, 1.7-5.7), and 20 infants had an isolated skull fracture (5.5% overall; 95% CI, 3.4-8.3). All outcomes were caused by falls onto hard surfaces. CONCLUSION: Most head injuries in infants younger than 3 months are benign, and the rate of ciTBI is low. Prevention strategies should focus on falls onto hard surfaces from furniture, strollers, and caregivers' arms. Optimizing imaging studies should be a priority in this population. WHAT IS KNOWN: • Infants younger than 3 months are vulnerable to minor blunt head trauma due to their age and to difficulties in assessing the subtle symptoms and minimal physical findings detected on examination. • A low threshold for CT scan is recommended in this population. WHAT IS NEW: • Most cases of blunt head trauma in infants younger than 3 months have good outcomes, and the rate of clinically important traumatic brain injury is low. • Optimizing imaging studies should be a priority in this population, avoiding X-ray examinations and reducing unnecessary CT scans.
Authors: Kimberly S Quayle; Elizabeth C Powell; Prashant Mahajan; John D Hoyle; Frances M Nadel; Mohamed K Badawy; Jeff E Schunk; Rachel M Stanley; Michelle Miskin; Shireen M Atabaki; Peter S Dayan; James F Holmes; Nathan Kuppermann Journal: N Engl J Med Date: 2014-11-13 Impact factor: 91.245
Authors: Elizabeth C Powell; Shireen M Atabaki; Sandra Wootton-Gorges; David Wisner; Prashant Mahajan; Todd Glass; Michelle Miskin; Rachel M Stanley; Elizabeth Jacobs; Peter S Dayan; James F Holmes; Nathan Kuppermann Journal: Pediatrics Date: 2015-03-16 Impact factor: 7.124
Authors: S A Schutzman; P Barnes; A C Duhaime; D Greenes; C Homer; D Jaffe; R J Lewis; T G Luerssen; J Schunk Journal: Pediatrics Date: 2001-05 Impact factor: 7.124