The changing "epidemiology" of pediatric head injury and its impact on the daily clinical practice.
OBJECTIVE
This article focuses on the developments that occurred during the last two decades in the management of pediatric head injury. It describes the changes in incidence, various advancements in diagnosis, management, prognosis, prevention and strategies required for better outcome, and control of head injury.


METHODS
Thorough evaluation of various papers, research, and our experience revealed that in developed countries, there has been a decreasing trend in head trauma incidence and trauma-related deaths as compared to developing countries.


RESULTS
This is mainly attributed to the widespread implementation of preventive measures. The development in imaging facilities, better characterization and grading of severe trauma (see, for example, diffuse axonal injury), an advanced understanding of the pathophysiology of secondary brain injury, endocrinological disturbances, predictive factors of outcome, development in neurophysiological monitoring, management advances in critical care units, implementation of safely measures, etc. have brought a significant change in overall outcome and profile of pediatric head injury


CONCLUSIONS
The further developments in field of brain plasticity, stem cell, rehabilitation, evolution of new drugs, preventive community measures, and global policies to deal with head trauma are expected to play a major role in days to come. The development of future pediatric trauma centers based on current evolutions (in order to achieve a good outcome), global and emphatic preventions of trauma will be required to establish equilibrium between developed and developing countries.
Kumar
Raj
R
Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, 226014, Uttar Pradesh, India. rajkumar@sgpgi.ac.in
Mahapatra
Ashok Kumar
AK
D000367:Age Factors; D001930:Brain Injuries / Q000209:etiology / Q000503:physiopathology / Q000534:rehabilitation; D002648:Child; D006259:Craniocerebral Trauma / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control*; D019049:Developed Countries; D003906:Developing Countries; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D009026:Mortality; D011379:Prognosis; D012737:Sex Factors; D016896:Treatment Outcome