Traumatic head injury in infants and toddlers.
OBJECTIVE
To describe the presenting characteristics, type of injury and hospital course in young children with traumatic head injury, and to identify characteristics indicating that the trauma was inflicted.


METHODS
A retrospective medical record review of 91 children less than 3 years of age who were admitted to a tertiary teaching hospital in Norway from 1995 through 2005 with a traumatic head injury. Patients were identified by diagnostic codes, and categorized by type of injury as skull fractures (n = 39), epidural haemorrhage (EDH) (n = 12), subdural haemorrhage (n = 27) and parenchymal brain injury (n = 13). Further the cases were classified as inflicted injury (n = 17), accident (n = 35) or indeterminate (n = 39).


RESULTS
The mechanism of injury was similar for EDHs and isolated skull fractures, and none were classified as inflicted. Sixty-three percent of the cases with subdural haematoma were classified as inflicted. When compared to the accident group, children in the inflicted group more frequently had subdural haemorrhage without a skull fracture (OR = 6.9, CI = 1.7-28.2), and seizures (OR = 9.5, CI = 2.1-43.3).


CONCLUSIONS
Inflicted and accidental head injuries differed in presenting characteristics and injury type. Nearly two-third of the subdural haemorrhages were classified as inflicted, but none of the epidural EDHs or skull fractures. Inflicted injuries tended to present with seizures.
Myhre
M C
MC
Department of Paediatric Intensive Care, Ullevål University Hospital, Oslo, Norway. mimy@uus.no
Grøgaard
J B
JB
Dyb
G A
GA
Sandvik
L
L
Nordhov
M
M
D000058:Accidental Falls; D000063:Accidents, Traffic; D001930:Brain Injuries / Q000453:epidemiology / Q000209:etiology*; D002649:Child Abuse; D002675:Child, Preschool; D005260:Female; D006407:Hematoma, Epidural, Cranial / Q000453:epidemiology / Q000209:etiology*; D006408:Hematoma, Subdural / Q000453:epidemiology / Q000209:etiology*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D007223:Infant; D007902:Length of Stay / Q000706:statistics & numerical data; D008137:Longitudinal Studies; D008297:Male; D009664:Norway / Q000453:epidemiology; D012189:Retrospective Studies; D012640:Seizures / Q000209:etiology; D012887:Skull Fractures / Q000453:epidemiology / Q000209:etiology*; D015996:Survival Rate