Major Causes of Head Trauma in Children Identified
Written by Editor   
Wednesday, November 26, 2014 12:56 PM

With prospective data on more than 43,000 head injuries in children younger than 19 years, researchers pinpoint the main causes of head trauma in different age groups, as well as the frequency of traumatic brain injury (TBI).  The new data, published in the November 13 issue of the New England Journal of Medicine.

Overall, 98% of the head injuries were mild, as defined by a Glasgow Coma Score (GCS) of 14 or 15; 1% were moderate, with a GCS of 9 to 13; and less than 1% (n = 354) were severe, with a GCS of 8 or lower. Seventy-eight children died.

In the overall population, the most common mechanism of injury was a fall from any distance (27%), followed by a fall while standing, walking, or running (11%); a collision with a stationary object when walking or running (6%); a motor vehicle crash (9%); and a bicycle crash (4%).

Among those injuries caused by a motor vehicle crash or a bicycle crash, a substantial proportion occurred when the child was not using a seat belt (36%) or wearing a helmet (72%).

The authors found that falls were the most frequent cause for TBI for children younger than 12 years, and assaults, motor vehicle accidents, and sports activities led to the most injuries for adolescents.

The rate of TBI as seen on CT was 5% for children with mild injuries, 27% for children with moderate injuries, and 65% for children with severe injuries.

Subdural hematoma was the most common injury overall, followed by subarachnoid hemorrhage and cerebral contusion. Almost half of the children in the CT group had more than one kind of brain injury.

Neurosurgeons treated 200 of the children in the CT group, and the types of neurosurgical procedures varied greatly.

"This prospective, multicenter study provides more detailed and representative clinical and radiographic information about the spectrum of [TBIs] in children than is available in previous studies of administrative databases or from single institutions," the researchers write.