Motor vehicle crash brain injury in infants and toddlers: a suitable model for inflicted head injury?
OBJECTIVE
Children involved in motor vehicle crash (MVC) events might experience angular accelerations similar to those experienced by children with inflicted traumatic brain injury (iTBI). This is a pilot study to determine whether the progression of signs and symptoms and radiographic findings of MVC brain injury (mvcTBI) in children of the age at greatest risk of iTBI could be evaluated with retrospective data. The ultimate goal was to examine the association of subdural hematoma (SDH) with initial loss of consciousness (LOC) and outcome.


METHODS
Retrospective review of records was conducted of 51 patients involved in a MVC, between birth and 36 months, admitted to Harborview Medical Center between January 1996 and December 2001. Radiographs were reviewed. Simple descriptive statistics and Fisher's exact test were used.


RESULTS
Ambulance reports were available for 57% of the patients, while Glasgow Coma Scale (GCS) scores (from any source) were only available for 76% of patients. Thirty-nine percent of patients sustained skull fractures, 8% long bone fractures, 20% thoracic injuries, and 8% intra-abdominal injuries. Twenty-four percent of the patients had SDHs; half of these experienced LOC. SDH patients without initial LOC had computed tomography findings and clinical courses indicative of focal impact injury, not angular acceleration.


CONCLUSIONS
Initial LOC and subsequent evolution of GCS scores are inconsistently documented in retrospective records. Seven of the 12 patients with SDHs had simple contact injuries, while 5 exhibited diffuse brain injury. Initial LOC was associated with diffuse brain injury and poor outcome. Due to the high rate of simple contact injury, mvcTBI may be a difficult model for iTBI.
Shah
Mahim
M
Department of Pediatrics, University of Washington School of Medicine, Seattle, WA 98122, USA.
Vavilala
Monica S
MS
Feldman
Kenneth W
KW
Hallam
Daniel K
DK
D000063:Accidents, Traffic; D001336:Automobiles; D001930:Brain Injuries / Q000145:classification / Q000000981:diagnostic imaging / Q000209:etiology*; D002675:Child, Preschool; D005260:Female; D015600:Glasgow Coma Scale; D006408:Hematoma, Subdural / Q000209:etiology; D006801:Humans; D007223:Infant; D008297:Male; D010865:Pilot Projects; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D014474:Unconsciousness / Q000209:etiology