Approach to head trauma in childhood in a district general hospital

Abstract

The authors compared the management of children with head trauma in a general hospital in two different periods (1984-85 and 1988-90). In the first period 233 cases were retrospectively evaluated; no guidelines were available at that time. In the second period 709 paediatric patients were treated following a protocol with indications for hospital admission and diagnostic procedures. In the clinical classes of milder symptoms (S0, S1, S2) a statistically significant reduction of hospital admission (p < 0.05) and skull radiography (p < 0.001) was achieved with the protocol without increasing the number of diagnostic errors, the incidence of clinical worsening because of an intracranial lesion was the same in the two periods (1.28% vs 1.27%). From our data and from the literature it emerges that it is necessary to clearly distinguish the children from 10 to 14 years of age from the rest of the paediatric population for major risk of intracranial complications, as in this group the presence of a skull fracture represents a high risk factor, predictive of an intracranial haematoma. In the children under 10 years, the history and the clinical status have greater importance in establishing the diagnostic procedure to be followed. The asymptomatic cases (S0) or those with mild symptoms (S1) can be sent home with an instruction sheet explaining the symptoms of possible complications, without any further diagnostic procedures.