Mode, presentation, CT findings and outcome of pediatric head injury

Abstract

Twenty five to thirty per cent of all patients admitted with head injuries to any large hospital are children. Head injuries in children differ in several ways from those seen in the adult population. A standard management protocol is used in a service hospital and CT and neurosurgical consultation/transfer is based on specific criteria. The records of 312 patients admitted with head injury to Command Hospital (WC), Chandimandir were retrospectively analysed to compare the mode of injury, initial presentation, CT findings and the outcome of management between those above and those below the age of 10 years. Eighty seven (27.8%) of the 312 patients were children and 71% of them had sustained the injury due to fall from a height. One third of children were brought with vomiting and drowsiness and 9.2% with seizures, but lateralizing signs were found in only 5.7%. Nineteen children underwent a CT of the head and of these 74% had only cerebral edema. Only 4 of the 87 children were transferred to a neurosurgical unit. The mortality rate was lower in children (5.7%) compared to the older age group (11.6%) but the difference was not statistically significant. However, a significantly higher number (80.5%) of children recovered without any residual deficit. Majority of our children can be safely managed in a general surgical unit provided a multidisciplinary approach is used and facilities of CT are readily available, since very few require active neurosurgical intervention.