Epidemiology of children with head injury: a national overview

Abstract

BackgroundThe National Confidential Enquiry describes the epidemiology of children admitted to hospital with head injury.MethodChildren (<15 years old) who died or were admitted for >4 h with head injury were identified from 216 UK hospitals (1 September 2009 to 28 February 2010). Data were collected using standard proformas and entered on to a database. A descriptive analysis of the causal mechanisms, child demographics, neurological impairment, CT findings, and outcome at 72 h are provided.ResultsDetails of 5700 children, median age 4 years (range 0–14.9 years), were analysed; 1093 (19.2%) were <1 year old, 3500 (61.4%) were boys. There was a significant association of head injury with social deprivation 39.7/100 000 (95% CI 37.0 to 42.6) in the least deprived first quintile vs. 55.1 (95% CI 52.1 to 58.2) in the most deprived fifth quintile (p<0.01). Twenty-four children died (0.4%). Most children were admitted for one night or less; 4522 (79%) had a Glasgow Coma Scale score of 15 or were Alert (on AVPU (Alert, Voice, Pain, Unresponsive)). The most common causes of head injury were falls (3537 (62.1%); children <5 years), sports-related incidents (783 (13.7%); median age 12.4 years), or motor vehicle accidents (MVAs) (401 (7.1%); primary-school-aged children). CT scans were performed in 1734 (30.4%) children; 536 (30.9%) were abnormal (skull fracture and/or intracranial injury or abnormality): 269 (7.6%) were falls, 82 (10.5%) sports related and 100 (25%). A total of 357 (6.2%) children were referred to social care because of child protection concerns (median age 9 months (range 0–14.9 years)).ConclusionsThe data described highlight priorities for targeted age-specific head injury prevention and have the potential to provide a baseline to evaluate the effects of regional trauma networks (2012) and National Institute of Health and Care Excellence (NICE) head injury guidelines (2014), which were revised after the study was completed.

National study shows that abusive head trauma mortality in Sweden was at least 10 times lower than in other Western countries

“…There could also be a difference in general child safety education. In a study by Trefan et al on the epidemiology of children with head injuries in the United Kingdom, home‐based safety interventions were recommended . Since 1979, all Swedish parents have received guidelines and education on child safety and been offered a visit by a midwife or nurse, who inspects the homes of new parents to ensure general safety measures are in place to prevent falls and other potential hazards and to minimise the dangers in the home environment.…”

Incidence and severity of head injury hospitalisations in Australian children over a 10‐year period

“…Head injuries are a global public health problem, especially among children, causing significant morbidity and mortality . Head injuries impact the social, cognitive and emotional development of children, and often result in ongoing support needs for the child and their family .…”

Is cranial computed tomography unnecessary in children with a head injury and isolated vomiting?

“…Nearly 35 000 children in the United Kingdom present to emergency departments with head injuries each year 1. These are largely minor injuries with normal or minimally impaired consciousness level.…”

“…Around 5% have intracranial complications with approximately 1% having clinically important traumatic brain injuries (box 1). 12…”

“…The associated radiation risk for an individual child is low, but it becomes important at a population level. For example, of 35 000 hospital episodes for children with a head injury in England,1 3500 children would have cranial CT performed based on a 10% CT rate suggested by the CHALICE rule study 4. A reasonable estimate is that one excess neoplasm may be expected per 3000-10 000 head CT examinations in children under 10 5.…”