Retrospective analysis of minor head injuries at the Department of Paediatrics, the Teaching Hospital and the Faculty of Medicine, Charles University in Pilsen in the years 2010–2014

Česká verzia

Authors: D. Cvalínová; V. Schwarzová; J. Fremuth; E. Sládková; J. Sýkora
Authors place of work: Dětská klinika, Fakultní nemocnice v Plzni, Univerzita Karlova v Praze, Lékařská fakulta v Plzni
Published in the journal: Čes-slov Pediat 2018; 73 (3): 132-138.
Category: Original Papers

Summary

Study objective:
Describe a patient sample hospitalized at the Nursery and Infant Unit of the Department of Paediatrics, the Teaching Hospital and the Faculty of Medicine, Charles University in Pilsen for minor head injuries after falls from small height for the years 2010–2014, and, on the basis of the PECARN score and own sample data analysis, define proper management of these patients.

Methods:
Retrospective analysis of medical records of patients up to the age of 1 year, hospitalized for minor head injuries. Descriptive evaluation of sample: evaluation of the mechanism of injuries (fall height, impact surface), evaluation of clinical findings (localization and extent of injuries, neurological findings), analysis of the results of laboratory and imaging assessments (ultrasound examination of brain, X-ray of the skull, CT/MRI of brain), and their recovery.

Results:
In the years 2010–2014, 5933 patients were hospitalized at the Nursery Unit of the Department of Paediatrics, the Teaching Hospital and the Faculty of Medicine in Pilsen, of which 614 for minor head injuries after falls from height. Most of the injuries of these children occurred at home. The sample consisted of 53% of boys and 47% of girls. In 7 cases, the children were indicated to CT (3) and MRI (4) of the head, and intracranial bleeding was reported in 3 patients. Two patients were indicated for surgical intervention. A statistically significant correlation was demonstrated between the localisation of injury and presence of fissure. Compared to patients with frontal injuries (p<0.0004), the patients with non-frontal injuries had a significantly higher incidence of fissure.

Conclusion:
On the basis of the retrospective analysis of our experience with children up to 1 year of age, hospitalized after falls on the head, we have proved that proper evaluation of medical history and clinical status are crucial to assess the risk of intracranial complications, and other additional examinations (for example: USG of the brain) are not beneficial in this respect. The PECARN scoring system allows safe identification  of patients indicated for graphic scan of the brain (CT/MRI). Children with skull fissures belong to the group of patients with a higher risk of complications.

Keywords:
minor head injury, head, PECARN score, risk, child

Zdroje

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