Methods:Retrospective study
Inclusion criteria:All chidren (0-12 years) admitted from March 1, 2017 February 28, 2018. (one year)
Exclusion criteria:Paediatric head injury cases treated outside for more than 24hrsTotal no of 108 patients have been admitted and treated; the entire above mentioned parameters were analyzed & studied.
Results:Ÿ There was a striking male preponderance (71%)Ÿ Most common presenting symptoms vomiting followed by post traumatic Loss of consciousnessŸ mean duration of hospital stay 4.8 days (with 84% staying less than 1 week).Ÿ Most common mode of injury RTA followed by Domestic injuries.Ÿ Most common indication for surgical intervention Depressed fracture followed by EDHŸ Good outcome in mild head injury cases and early presentationConclusion:Through the retrospective analysis made at Thanjavur medical college hospital trauma unit, we found that there is an alarmingincrease in pediatric head injuries in rural areas with cases of assault and battered baby on the rise. We emphasize the importanceof pre hospital care, early referral and need to improve safety measures, road infrastructure,etc., and the need to sensitize thepeople regarding the same.
INTRODUCTION:Head injury is a major health problem in developing countries likeIndia. It is a leading cause of death and disability in pediatricpopulation. This places a huge economic burden and makesconsiderable demands on health services in a country. Indeveloping countries, the number of vehicles is increasing in ruraland urban areas not concurrent with developing roadinfrastructures. This leads to increased RTA. Head injuries accountfor one quarter to one-third of all accidental deaths, and for twothirds of trauma deaths in hospitals. Head injury accounts for thelargest cause of acquired disability in childhood. There are no clearrecommendations or steps in reducing such traumas and opinionsare deviating. The proposed management regimes are not alwaysoptimal or easily applied in pediatric cases. The study focuses onunderstanding the etiology, clinical presentation, treatmentoptions, and outcome of these patients and to strengthen theseaspects of pediatric trauma care in a peripheral tertiary care centrewith emphasis on preventive issues and imparting healtheducation to the personal involved in handling such cases.Materials and MethodsPlace of study Thanjavur Medical college hospital, Thanjavur,Tamilnadu, India.Study design Retrospective observational study.Study duration March 1, 2017 February 28, 2018.Inclusion criteria Children (under 12 years of age) presentingwith head trauma between March 1, 2017 and February 28, 2018.All cases with positive imaging findings in CT/MRI.Exclusion criteria Paediatric head injury cases treated outside formore than 24hrs.Sample size 108.OBSERVATION AND RESULTS:AGE-SEX DISTRIBUTIONA total of 108 cases were analyzed and there was a significantmale preponderance noted. 76(71%) male and 32(29%) femalechildren at a ratio of 2.21: 1 (M:F). 48(63%) of the male childreninjured were between the age group of 5-8 yrs which was found tobe statistically significant whereas female children with headinjuries were uniformly distributed across all age groups as shownin table 1.TABLE 1MODE OF INJURY AND SEVERITY:The most common and significant mode of injury was road trafficaccident as seen in Table 2 with 50(47%) children involved in thesame, followed by accidental fall 44(40%). 11 cases of assault wasnoted and 3 battered babies were also seen in our study. Theseverity of injury was assessed as per the Glasgow coma scoringsystem as shown in table 3. They were classified accordingly asMild (GCS13-15), Moderate (8-12) and Severe (<8) head injury.59(55%) children had mild head injury, 35(32%) had moderateand (13%) had severe head injury.TABLE 2Dr. MathiyashArthur Professor, Dept of Neurosurgery, Thanjavur medical college hospital, Thanjavur. ABSTRACTAim/Objective:To conduct a survey on paediatric Head injury in a peripheral tertiary health centre and to analyze the various epidemiologicalfactors like incidence, age, sex, mechanism/type of injury, associate injuries, presentation, CT findings, management, period ofstay, Outcome (Condition at discharge).Methods:Retrospective studyInclusion criteria:All chidren (0-12 years) admitted from March 1, 2017 February 28, 2018. (one year)Exclusion criteria:Paediatric head injury cases treated outside for more than 24hrsTotal no of 108 patients have been admitted and treated; the entire above mentioned parameters were analyzed & studied.Results:Ÿ There was a striking male preponderance (71%)Ÿ Most common presenting symptoms vomiting followed by post traumatic Loss of consciousnessŸ mean duration of hospital stay 4.8 days (with 84% staying less than 1 week).Ÿ Most common mode of injury RTA followed by Domestic injuries.Ÿ Most common indication for surgical intervention Depressed fracture followed by EDHŸ Good outcome in mild head injury cases and early presentationConclusion:Through the retrospective analysis made at Thanjavur medical college hospital trauma unit, we found that there is an alarmingincrease in pediatric head injuries in rural areas with cases of assault and battered baby on the rise. We emphasize the importanceof pre hospital care, early referral and need to improve safety measures, road infrastructure,etc., and the need to sensitize thepeople regarding the same.Dr. HariharasudanR*Neurosurgery resident, Dept of Neurosurgery, Thanjavur medical college hospital,Thanjavur.*Corresponding AuthorAGE MALE FEMALE0-4 09 115-8 48 1009-12 19 11Mode of InjuryRTA 50Accidental fall 44Assault 11Battered baby 324 www.worldwidejournals.comPARIPEX - INDIAN JOURNAL OF RESEARCH Volume-7 | Issue-5 | May-2018 | PRINT ISSN No 2250-1991 TABLE 3TIME OF PRESENTATION:83(76%) of the total 108 patients were brought to the ER within6hrs of trauma. The rest presented after 6 hours and within 12 hrs.There was a significant improvement seen in outcome of patientswho presented early.TABLE 4SYMPTOMS ON ADMISSION:66 children presented with vomiting as the predominant symptomat the time of admission, followed by Loss of consciousness in 37,seizure in 33, ENT bleed was the presenting complaint in 30 and 12presented with headache.TABLE 5IMAGING FINDINGS:All the children included in the study were subjected to imaging,either CT or MRI and 53(49%) were found to have calvarialfractures, of which 25 were depressed fractures and 28 were linearfractures. The most common site of fracture was frontal bonefollowed by temporal. 20 were found to have diffuse injury. A totalof 44 cases had intracranial hemorrhages. 17 cases were found tohave EDH, 8 SDH, 2 ICH and 26 SAH. 1 child presented with crushinjury to head and CT imaging revealed EDH/SDH and ICH alongwith calvarial fracture.TABLE 6MANAGEMENT/ OUTCOME:61 patients of the total 108 were managed conservatively and 47underwent surgery. There were 33 deaths (1 ICH, 1 SDH, 1ICH/SDH/EDH). 97% had a favorable outcome as per the Glasgowoutcome score. The morbidity in children was less compared toadults.TABLE 7PERIOD OF STAY:The mean duration of hospital stay was 4.8 days and 84% ofchildren were staying less than a week in hospital.Discussion:India is a youth nation with population between the 12 year agegroup comprising of around 28-30%. Head Injury in infancy andchildhood has been documented as the single most commoncause of death. There is a significant difference between themodes of injury, the mechanisms of damage, and themanagement of specific problems between the adult and pediatricpopulations. Most of the studies on pediatric head injury haveconfirmed a male preponderance (71% of cases). Road trafficaccidents and fall from height has been cited by most studies as themost common cause of pediatric head injury, followed by sportsinjuries, and various other mechanisms like ballistic injuries. Noneof the studies mention about assaults and battered baby. Ourstudy showed significant number of RTAs as the cause of pediatrichead injury followed closely by accidental falls, there was asignificant number of assaults and battered baby (13%) in the ruralareas our hospital caters to.This study was carried out in a peripheral tertiary health care centreto analyze the clinical profile of paediatric head injury in relation toage distribution, sex, mode of injury, types of injuries, imagefindings, duration of hospital stay and outcomes. Our results are inaccordance showing RTA as the most common cause of pediatrichead injury as shown by Osmond et al. from Canada. The mostcommon lesion seen on CT scan was an extradural hematoma(EDH) and Fractures. There was a significant number of fracturesnoted especially involving the frontal bone followed by thetemporal bone. Mahapatra reports contusion as the most commonCT finding. Vomiting was seen in 62% of our children; a similarincidence has been reported by others also .This study found thatin rural areas head injury mostly affects young boys, due to RTAand accidental falls. But assaults and battered baby incidenceswere also in significant number. Low Glasgow coma score atadmission and delay in presentation was significantly associatedwith increased mortality and morbidity.This increase in number of RTA in rural India was mostly due toincrease in vehicular population but no significant improvement inroad infrastructures. Though most vehicle ownership is in theurban areas, a vast number of highways pass through rural andremote areas with extensive use of heavy motor vehicles travellingat high speed. Residential areas and highways are not segregated,and safety laws are not universally applied in our country.Many interventions (e.g., road lighting, traffic signals, guardrailing, seatbelts, helmets, airbags, and antilock brakes) have alsodemonstrated success in more industrialized setting and are likelyto be valuable in resource-constrained setting such as India. Thereis total disregard for personal safety like use of helmets andseatbelts, people need to be imparted education on theimportance of same, especially in rural areas. For example, in theUnited States, the rate of motor vehicle-related TBI fatalitiesdecreased substantially from 11.4/100,000 in 19796.6/100,000in 1992 due to the strict implementation of such safetymechanisms.This decrease was largely attributed to an increase in seat belt andchild safety seat use, standardized implementation of air bags,infrastructure investments, and improved safety engineering. InIndia, vehicles, especially those designed locally need to improveon build quality and increasing the safety features to European/American standards.There is a need to improve pre hospital care to reduce morbidityand mortality. Apart from safety laws, prompt transport to ahospital after an accident is another important measure to reducemortality as shown in our study. This was due to the governments108 initiative (rapid response centralized system) in the state ofTamilnadu. The majority of patients in rural India are still broughtto the emergency department by relatives or bystanders in privatevehicles, and prehospital emergency medical services remain GCS TotalTotalMild 13-15 59Moderate 18-12 35Severe <8 14TIME OF PRESENTATION<6hrs 836-12 hrs 25SYMPTOMS TOTALVomiting 66LOC 37Seizures 33ENT bleeds 30Headache 12IMAGING FINDINGS TOTALEDH 17SDH 08ICH 02SAH 16CALCARIALFRACTURE(Depressed -25,Linear-28)53CRUSH INJURY WITHICH/EDH/SDH01DIFFUSE INJURY 20DIAGNOSIS TOTAL NO OF SURGERYDepressed Fracture 25EDH 13SDH 07ICH 02www.worldwidejournals.com 25PARIPEX - INDIAN JOURNAL OF RESEARCH Volume-7 | Issue-5 | May-2018 | PRINT ISSN No 2250-1991 under-organized. Field triage often relies on bystanders whotransport injured victims to the nearest clinic, which is often unableto provide appropriate treatment.Major urban areas also have a loosely networked trauma system,untrained emergency medical services personnel, and unequippedambulances. Our observation of family and bystander transportsupports the notion that prehospital care in rural India requiresmuch improvement. The incidence of RTAs is more during holidaysand weekends. Increased vigilance by the traffic personnel andrapid response ambulance services during these periods willreduce the burden of such cases. Children play in the streets, haveless supervision of the parents and above all there is lack of safetymeasures in place where they play. Males predominate was alsoseen in our study also. The male:female ratio being 2:1. Most ofthe USA reports show an incidence ratio of 2.0 or more for malescompared to females. One of the series of 672 patients had 533male and 139 female patients. Our observation corresponds withthe observations made by other authors. The reason is that malechild move out more frequently than female child. Our study alsoshowed increase in incidences of assault even in pediatricpopulations and the need to protect such vulnerable groups.Our results are in accordance showing age group 5-8 had mostcases n = 58 (54%) cases, followed by 9-12 age group (n = 30)(28%). This is consistent with data reported from other studies,where the highest incidence of head trauma was found in the610 age groups.Conclusion:Our study showed that there is a male preponderance to pediatrichead injury and RTA followed by accidental fall is the mostcommon cause, this in accordance with many national andinternational studies. The most common age group is 5-10 yrs.The most common lesion seen on CT scan was fracture and EDH,and frontal bone being the most common site. Vomiting and LOCare the most common presenting symptoms followed by seizures.The importance of improving road infrastructure and safetymeasures, along with supervision of children during play isemphasized.Good outcome was noted in patients whose admission GCS wasgood and in patients who presented within 6hrs of primary insult.The need to improve pre hospital care and early response system isrecognized by this result.The increasing trend of assaults and battered baby in ruralpopulation needs to be addressed. A centralized state or nationallevel urban/rural data of chain of events leading to the accidents inpediatric head injury, with factors relating to favorable outcomewill be extremely helpful in policy making and health managementat the national level in India.References1. Jennett B. Epidemiology of head injury. J Neurol Neurosurg Psychiatry1996;60:362-9.2. Jennett B. Epidemiology of head injury. Arch Dis Child 1998;78:403-6.3. Luerssen TG, Klauber MR, Marshall LF. 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