Pattern of Pediatric Trauma in Rural Background of Central India.

Background: Trauma is emerging as an epidemic and a leading cause of morbidity and mortality in children. Children <15 years of age comprise about 32.8% or 1/3th of the total Indian population. In India, up to one-fourth of hospital admissions and approximately 15% of deaths in children are due to injury. The burden of child injuries in India is not clearly known, as there is a lack of proper trauma database in India and even in Indian studies the population covered was metro city based. Aim: The present study aims to analyze the different aspects related to trauma in children particularly from rural background. Materials and Methods: A prospective, observational study was carried out in 510 patients of the age group 0-15 years admitted to the surgical wards of a tertiary care hospital, with a history of trauma during the period from August 2013 to July 2014. Results: Incidence of pediatric trauma was found to be 20.08%. The cases among males were 297 (58.24%) and females were 213 (41.76%) with male:female ratio of 1.39:1. Road traffic accidents (RTA) 32.15% and fall from height (30.78%) were the most common modes of injury. Isolated head injuries 216 (60.5%) were the leading type of injuries. Poly-trauma patients had the highest mortality rates. Conclusion: RTA and fall from height are the most common causes of pediatric trauma. Pediatric trauma and injury are preventable conditions. Educating the health care providers about the pediatric trauma care centers and the establishment of the same at nodal or tertiary care centers is advisable for the proper treatment of pediatric trauma victims. The management of pediatric trauma is specialized teamwork.

Clinical decision rules for the application of computed tomography in children with minor head injury / 中国小儿急救医学

Pediatric head injury is the leading cause of death and disability,about 40% to 60% of kids of head injury get a CT,and the majority are those with minor head injury,about 10% of these CT scans are positive.Clinical decision rules for pediatric head injury exist to identify children at risk of traumatic brain injury.Those of the highest quality are children's head injury algorithm for the prediction of important clinical events(CHALICE),Pediatric Emergency Care Applied Research Network(PECARN)and the Canadian as-sessment of tomography for childhood head injury(CATCH)clinical decision rules.This review aimed to systematically introduce primary clinical decision rules for children with minor head injury and compare them for diagnostic accuracy in detecting intracranial injury and injury requiring neurosurgery.

Chronic brain abscess secondary to a retained wooden foreign body: Diagnostic and management dilemmas.

A four-year-old child presented with recent onset generalized tonic clonic seizures. She was operated for a suspected intracranial tuberculoma and was found to harbor an intra-parenchymal retained wooden foreign body with a chronic abscess. The foreign body had entered the brain parenchyma after a minor head injury, sustained three years earlier. She was asymptomatic for the intervening three years. The initial diagnosis was missed by several physicians. A retained wooden fragment via a transtemporal apparently closed head injury is an extremely rare event. The present study reveals the diagnostic and therapeutic challenges and stresses the importance of high degree of suspicion to diagnose retained intracranial foreign bodies and the need for early surgical exploration, to avoid chronic and potentially life threatening neurological complications.

A Clinical Analysis of Pediatric Head Injuries

OBJECTIVES: With the advancement of a social life, the pediatric head injuries(PHI) occur greater than ever. Since the PHI differs from adult head injury with regards to mechanism of trauma, prognosis, and mortality, it is important to identify the characteristics of the PHI for its proper treatments and prognosis. METHODS: For this study, a series of 365 PHI patients under 15 years of age who were admitted to our hospital, were evaluated from January 1991 to December 1996. The clinical variable studied were age, sex, Glasgow coma score(GCS), causes of trauma, diagnosis, symptoms, associated injuries and Glasgow outcome score (GOS). The characteristics of PHI were evaluated according to presentations of skull fractures, intracranial hemorrhages, associated injuries, GCS at admission and GOS. RESULTS: Mean age of the studied patients was 6.51 years of age. The majority of PHI patients were under the 7 years of age(66.7%). The ratio of male to female was 2.2:1. Seasonally, PHI occurred more frequently during March to August(61.6%). The main causes of the injuries were accidental falls and traffic accidents(47.1% and 46.3%). One hundred ninety seven(54%) patients suffered from skull fractures and 110(30.1%) patients were developed intracranial hemorrhages and acute epidural hematomas(17.8%) which were the most common intracranial hemorrhages. There was statistical significance between skull fractures and intracranial hemorrhage (p=0.032) and between GCS and GOS(p=0.001). However, there was no statistical significance between skull fractures and intracranial hemorrhage(epidural hematomas, subdural hematomas, and intracerebral, intraventricular and subarachnoid hemorrhage)(p=0.061, 0.251 and 0.880). Also there were no significance of prognosis between under the seven and over the 8 years of age(p=0.349). CONCLUSIONS: The core management for PHI is prevention from its occurrences. However, when unexpected accident occurs, early diagnosis and treatment for PHI by through examination for associated injuries and other damages even if there is no skull fracture are essential in managing patient's outcome.

Pediatric Head Injury

Pediatric head injury is a leading cause of disability or death in children. Reducing morbidity and mortality require careful attention to the factors leading to poor prognosis. In this regards authors reviewed the clinical features of pediatric head injury to find out the prognostic factors. From 1992 to 1996, 96 pediatric head injury patients were admitted to our hospital. Seventy eight of them(81.3%) were transferred from the other hospitals. Pedestrian vehicle accident and fall were the leading causes. Clear or drowsy patients account for 42.7 %, stuporous, semicomatose or comatose, 57.3%. Early seizures were noted in 18(18.8%). Outcome were good in 68(70.8%), moderate to severe disability 18(18.8%), vegetative 3(3.1 %), and died 7(7.3%). Consciousness level was the most significantly related with poor prognosis. Radiological deterioration, hematoma or edema, was noted in thirteen patients, and their prognosis was significantly worse than others(p=0.01). Those patients with complications occurred during admission such as pneumonia or electrolyte imbalance showed poorer prognosis (p<0.05). In conclusion outcome of the pediatric head in Jury was significantly related to the initial mentality, worsening of hematoma or edema on follow up CT scan, and complications such as pneumonia and electrolyte imbalance during admission . Early recognition of these factors would contribute to the improvement of the outcome of the pediatric head injury patients.

Clinical Features and Prognostic Factors of Head Injury in Less Than Two-Year-Old Children

The brain and intracranial compartment undergo a multiplicity of physiologic and anatomical changes which influence the type of head injury and response to such injury, especially for those children in first two years of age in whom development of skull and brain is still undertaking. Thus, special attention to recognize and manage these children from such injury seems mandatory. Purpose of this study is to analyze the related causes for the head injury in this age group with various clinical parameters influencing the outcome. A total of 68 children less than two years of age who were admitted to our institution after head trauma were included in this retrospective study. The causes of head injury along with other clinical settings, such as type of pathologies, Pediatric Glassgow Coma Scale(PGCS), age, operation, hypoxia, shock, seizure, anemia, abnormal pupillary response, were reviewed and clinical outcome related with these parameters were analysed. The mean duration of admission period was 15 days and mean follow-up period was 29.4 months. Most common mode of injury was stairway injury(32.3%), followed by in-car accident(19.1%), with suspected child abuse being only 2.9%. Cerebral contusion was the most frequent diagnosis being 43 cases(63.2%), followed by skull fracture in 31(45.6%). For the outcome related to various categories, 5 cases of death were due to diffuse axonal injury or intracranial hemorrhage, but most simple linear fractures were not associated with underlying brain injury. Among those required the operation(18 cases), subdural and/or epidural hematoma were the most common pathology(50%), followed by subdural hygroma and depressed skull fracture. The outcome, however, was not related to type of pathology. Instead, it was rather closely related to the initial PGCS. The PGCS at admission was found out to be the major predicting factor to outcome. In overall, 34/36(94.4%) cases with normal PGCS in these age groups showed good recovery with deaths being 5/7(71.4%) cases of PGCS

Outcome Following Diffuse Brain Injury in Children

No abstract available.