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Patterns, outcomes, and risk factors of mild head injuries in children: do we know enough?


Published: Apr 3, 2022
Keywords:
mild head injury children concussion head trauma risk-factors
Xenophon Sinopidis
https://orcid.org/0000-0002-0878-0668
Panagiotis Kallianezos
https://orcid.org/0000-0003-1822-323X
Constantinos Petropoulos
Despoina Gkentzi
Sotirios Fouzas
https://orcid.org/0000-0001-7617-9076
Ageliki Karatza
Vasileios Panagiotopoulos
Ioannis Spyridakis
Stylianos Roupakias
George Sakellaris
Eleni Jelastopulu
https://orcid.org/0000-0001-7499-4034
Abstract

Background: Mild head injuries in children are associated with morbidity and family distress. Though they are common causes of emergency department visits, they have been studied less than other more severe types of head trauma. This study aims to contribute to the reduction of this gap.


Method and Materials: The medical records of 381 children with mild head injuries were reviewed and analyzed. Identification of any associated risk factors has been attempted with regression analysis.


Results: The age group of 6-8 years was the most affected (44.6%). There was male predominance. Incidence presented seasonal variation. Concussion diagnosis was set in one tenth of patients. Half of children were under adult supervision during the traumatic incident. Cranial radiography was routinely performed in almost all patients, and computed tomography in 1.8%. Neurosurgical consultation was requested in 8.1%. Pedestrians, bicycle-riders, and car-passengers were at most risk of suffering mild head injury. Occurrence at street and playgrounds were risk factors for coexisting abdominal injuries. Absence of adult supervision was a risk factor for bicycle-riders, and occurrence at school for neurosurgical consultation.


Conclusions: Mild head injuries occur more often at the streets of urban areas. Clinical observation for 24 hours is considered satisfactory for a safe outcome. Identification of risk factors of mild head injuries may improve both prevention and outcome. Improvement of training of physicians in pediatric trauma is also required. Quality of adult supervision is important to improve prevention.

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Author Biographies
Despoina Gkentzi, Department of Pediatrics, University of Patras School of Medicine, Patras, Greece

Assistant Professor

Sotirios Fouzas, Department of Pediatrics, University of Patras School of Medicine, Patras, Greece

Assistant Professor

Ageliki Karatza, Department of Pediatrics, University of Patras School of Medicine, Patras, Greece

Associate Professor

Vasileios Panagiotopoulos, Department of Neurosurgery, University of Patras School of Medicine, Patras, Greece

Associate Professor

Ioannis Spyridakis, Department of Pediatric Surgery, Papageorgiou Hospital, Aristotle University School of Medicine, Thessaloniki, Greece

Department of Pediatric Surgery

Associate Professor

Stylianos Roupakias, Department of Pediatric Surgery, Papageorgiou Hospital, Aristotle University School of Medicine, Thessaloniki, Greece

Department of Pediatric Surgery

Academic Fellow

George Sakellaris, Department of Pediatric Surgery, Heraklion University Hospital, Heraklion, Greece

Department of Pediatric Surgery

Consultant

Eleni Jelastopulu, Department of Public Health, University of Patras School of Medicine, Patras, Greece

Department of Public Health

Professor

References
Cassidy JD, Carroll LJ, Peloso PM, Borg J, von Holst H, Holm L, et al. Incidence, risk factors and prevention of mild trau-matic brain injury: results of the WHO Collaborating Centre Task Force on Mild Traumatic Brain Injury. J Rehabil Med 2004; 43 Suppl: 28-60. https://doi.org/10.1080/16501960410023732
Heskestad B, Baardsen R, Helseth E, Rornner B, Waterloo K, Ingebrigtsen T. Incidence of hospital referred head injuries in Norway: a population-based survey from the Stavanger region. Scand J Traum Resusc Emerg Med 2009; 17:6. https://doi.org/10.1186/1757-7241-17-6
Koepsell TD, Rivara FP, Vavilala MS, Wang J, Temkin N, Jaffe KM, et al. Incidence and descriptive epidemiologic features of traumatic brain injury in King County, Washington. Pe-diatrics 2011; 128: 946-54. https://pubmed.ncbi.nlm.nih.gov/21969286/#:~:text=10.1542/peds.2010%2D2259.
Keane OA, Escobar Jr MA, Neff LP, Mitchell IC, Chern JJ, Santore MT. Pediatric Mild Traumatic Brain Injury: Who can be managed at a non-pediatric trauma center hospital? A systematic review of the literature. Am Surg 2021; 31348211050804. https://doi.org/10.1177/00031348211050804
Andelic N, Anke A, Skandsen T, Sigurdardottir S, Sandhaug M, Ader T, et al. Incidence of hospital-admitted severe traumatic brain injury and in-hospital fatality in Norway: a national cohort study. Neuroepidemiology 2012; 38: 259–67. https://doi.org/10.1159/000338032
Poussaint TY, Moeller KK. Imaging of pediatric head trau-ma. Neuroimag Clin N Am 2002; 12:271-94. https://pubmed.ncbi.nlm.nih.gov/12391636/#:~:text=doi%3A%2010.1016/s1052%2D5149(02)00005%2D9.
Kirkwood MW, Yeats KO, Taylor HG, Randolph C, McCrea M, Anderson VA. Management of pediatric mild traumatic brain injury: a neuropsychological review from injury through recovery. Clin Neuropsychol 2008; 22: 769-800. https://doi.org/10.1080/13854040701543700
Marshall S, Bayley M, McCullagh S, Velikonja D, Berrigan L. Clinical practice guidelines for mild traumatic brain injury and persistent symptoms. Can Fam Physician 2012; 58:257-67, e128-40. http://www.ncbi.nlm.nih.gov/pmc/articles/pmc3303645/
Kallianezos P, Sinopidis X, Petropoulos C, Gkentzi D, Plotas P, Fouzas S, Karatza A, Jelastopulu E. Anxiety and depres-sion among parents of children with mild head injuries. Eur Rev Med Pharmacol Sci 2021; 25: 1530-35. https://doi.org/10.26355/eurrev_202102_24861
McCrory P, Meeuwisse WH, Aubry M, Cantu B, Dvorak J, Echemendia RJ, et al. Consensus statement on concussion in sport: the 4th international conference on concussion in sport held in Zurich, November 2012. J Am Coll Surg 2013; 216: e55-71. https://pubmed.ncbi.nlm.nih.gov/23582174/#:~:text=10.1016/j.jamcollsurg.2013.02.020.
McCrory P, Meeuwisse WH, Aubry M, Cantu B, Dvorak J, Echemendia RJ, et al. Consensus statement on concussion in sport: the 4th international conference on concussion in sport held in Zurich, November 2012. Br J Sports Med 2013; 47: 250-8. https://pubmed.ncbi.nlm.nih.gov/23479479/#:~:text=doi%3A%2010.1136/bjsports%2D2013%2D092313.
Kuppermann N, Holmes JF, Dayan PS, Hoyle Jr JD, Atabaki SM, Holubkov R, et al. Identification of children at very low risk of clinically important brain injuries after head trauma: a prospective cohort study. Lancet 2009; 374:1160-70. https://doi.org/10.1016/s0140-6736(09)61558-0
Klassen TP, Reed MH, Stiell IG, Nijssen-Jordan C, Tenenbein M, Joubert G, et al. Variation in utilization of computed to-mography scanning for the investigation of minor head trauma in children: a Canadian experience. Acad Emerg Med 2000; 7:739-44. https://pubmed.ncbi.nlm.nih.gov/10917321/#:~:text=doi%3A%2010.1111/j.1553%2D2712.2000.tb02260.x.
Astrand R, Roselund C, Undeh J, Scandinavian Neurotrau-ma Committee (SNC). Scandinavian guidelines for initial management of minor and moderate head trauma in chil-dren. BMC Medicine 2016; 14: 33. https://doi.org/10.1186/s12916-016-0574-x
Bowman SM, Bird TM, Aitken ME, Tilford JM. Trends in hospitalizations associated with pediatric traumatic brain injuries. Pediatrics 2008; 122: 988-93. https://doi.org/10.1542/peds.2007-3511
Fabbri A, Servadei F, Marchesini G, Negro A, Vandelli A. The changing face of mild head injury: Temporal trends and patterns in adolescents and adults from 1997 to 2008. Injury 2010; 41:913-7. https://doi.org/10.1016/j.injury.2010.03.002
Keenan HT, Bratton SL. Epidemiology and outcomes of pediatric traumatic brain injury. Develop Neurosc 2006; 28: 256-63. https://doi.org/10.1159/000094152
Anderson EH, Bjorklund R, Emanuelson I, Stalhammar D. Epidemiology of traumatic brain injury: a population-based study in western Sweden. Acta Neurol Scand 2003; 107: 256-9. https://doi.org/10.1034/j.1600-0404.2003.00112.x
Skandsen T, Einarsen CE, Normann I, Bjoralt S, Karlsen RH, McDonagh D, et al. The epidemiology of mild traumatic brain injury: the Trondheim MTBI follow-up study. Scand J Trauma Resusc Emerg Med 2018; 26:34. https://doi.org/10.1186/s13049-018-0495-0
Thurman DJ. The epidemiology of traumatic brain injury in children and youths: a review of research since 1990. J Child Neurol 2016; 31:20-7. https://doi.org/10.1177/0883073814544363
Santos ME, De Sousa L, Castro-Caldas A. Epidemiology of craniocerebral trauma in Portugal. Acta Med Port 2003; 16: 71-6. https://pubmed.ncbi.nlm.nih.gov/12828007/#:~:text=expand-,PMID%3A%2012828007,-Free%20article
Feigin VL, Theadom A, Barker-Collo s, Starkey NJ, McPher-son K, Kahan M, et al. Incidence of traumatic brain injury in New Zealand: a population-based study. Lancet Neurol 2013; 12: 53-64. https://doi.org/10.1016/s1474-4422(12)70262-4
Coronado VG, Xu L, Basavaraju SV, McGuire LC, Wald MM, Faul MD, et al. Surveillance for traumatic brain injury-related deaths. United States-1997-2007. MMWR Surveill Summ 2011; 60:1-32. https://pubmed.ncbi.nlm.nih.gov/21544045/#:~:text=expand-,PMID%3A%2021544045,-Free%20article
Massey K, Kant S, Violano P, Roney L, King W, Justice W, et al. Evaluating distracted driving behaviors in parents of children in suburban and rural areas of Alabama. J Trauma Acute Care Surg 2016; 81(4 Suppl 1): S44-7. https://doi.org/10.1097/ta.0000000000001181
Iyer S, Patel G. Study of risk factors, clinical spectrum, and outcome for head injury in pediatric age group in Western India. Afr J Paediatr Surg 2020; 17: 26-32. https://pubmed.ncbi.nlm.nih.gov/33106450/#:~:text=doi%3A%2010.4103/ajps.AJPS_2_18.
Guzel A, Hicdonmez T, Temizoz O, Aksu B, Aylanc H, Ka-rasalihoglu S. Indications for brain computed tomography, and hospital admission in pediatric patients with minor head injury: how much can we rely upon clinical findings? Pediatr Neurosurg 2009; 45: 262-70. https://doi.org/10.1159/000228984
Schonfeld D, Fitz B, Nigrovic LE. Effect of the duration of emergency department observation on computed tomog-raphy use in children with minor blunt head trauma. Ann Emerg Med 2013; 63:597-603. https://doi.org/10.1016/j.annemergmed.2013.06.020
Colvin JD, Thurm C, Pate BM, Newland JG, Hall M, Meehan 3rd WP. Diagnosis and acute management of patients with concussion at children's hospitals. Arch Dis Child 2013; 98:934-8. https://doi.org/10.1136/archdischild-2012-303588
Hall P, Fransson A, Martens A, Johanson L, Leitz W, Gran-ath F. Increased number of cancer cases following com-puter tomography in children. Radiation dosage-and can-cer risk-can be reduced. Lakartidningen 2005;102:214-5. PMID: 15743131
Brenner D, Elliston C, Hall E, Berdon W. Estimated risks of radiation-induced fatal cancer from pediatric CT. AJR Am J Roentgenol 2001; 176:289-96. https://doi.org/10.2214/ajr.176.2.1760289
Brenner DJ, Hall EJ. Computed tomography-an increasing source of radiation exposure. N Engl J Med 2007; 357:2277–84. https://doi.org/10.1056/nejmra072149
Pearce MS, Salotti JA, Little MP, McHugh K, Lee C, Kim KP, et al. Radiation exposure from CT scans in childhood and subsequent risk of leukaemia and brain tumours: a retro-spective cohort study. Lancet 2012; 380:499–505. https://doi.org/10.1016/s0140-6736(12)60815-0