gms | German Medical Science

Objective: Infants and toddlers are prone to head injuries. The following is a single center analysis of TBI in infants and toddlers including injury mechanisms and risk factors for neurosurgical procedures.

Methods: After ethics approval, all patients under age 5 treated at both university hospitals from 1/2009-8/2014 for diagnoses including “traumatic brain injury” were included. Retrospective analysis of the electronic patient chart was performed for demographics and accident mechanism, initial neurological status with respect to initial symptoms, diagnostics, diagnoses, length of stay, and all intracranial procedures. Analyses were performed with Chi Square Analysis (Fisher’s exact). P<0.05 was considered significant.

Results: 130 patients under 5 years were identified (mean: 1.98, range: 0.1–4.0). Nine were admitted intubated. Diagnostics: 44 underwent CCT, 17 cMRT, 16 cranial ultrasound, 53 clinical observation. Length of stay in total: 1–35 days (mean: 4.7 days), on ICU: 0–19 days (mean: 3.9 days). Injury mechanisms included falls (56.2%), blunt injury to the head (11.5%), automobile accidents (6.2%), suspected child abuse (5.4%) and other mechanisms (20.7%). The majority of falls were from 1–3m height (n=27, 37% of falls), followed by under 1 m (n=23, 32%) and from the patient’s own height (n=19, 26%). Only 4 cases were above 3 m (5%). Diagnoses were “severe” (EDH, SDH, traumatic SAH, ICH and/or skull fracture) in 22 (16.9%) children and “mild” (skull bruise, concussions, superficial injury) in 106 (81.5%), 2 are missing. 4 were fatal (0.03%). None of the 3 falls >3 meters suffered “severe” injury, whereas 3/23 falls under 1 m suffered “severe” injury. A history of loss of consciousness was documented in 43 patients; which was not a significant risk factor for neurosurgical operations (p=0.414). However, intubation on admission was significantly associated with neurosurgical procedures (p=0.035). Suspected child abuse was also significantly associated with neurosurgical procedures (p=0.000).

Conclusion: Falls are the most common injury mechanism in infants and toddlers. Low falls can be associated with intracranial hemorrhage and/or fracture. Injuries requiring intubation initially are associated with neurosurgical procedures as is suspected child abuse.