Head injury depth as an indicator of causes and mechanisms.
OBJECTIVE
The goal was to measure differences in the causes, mechanisms, acute clinical presentations, injuries, and outcomes of children <36 months of age with varying "greatest depths" of acute cranial injury.


METHODS
Children <36 months of age who were hospitalized with acute head trauma were recruited at multiple sites. Clinical and imaging data were collected, and caregivers underwent scripted interviews. Neurodevelopmental evaluations were completed 6 months after injury. Head trauma causes were categorized independently, and subject groups with varying greatest depths of injury were compared.


RESULTS
Fifty-four subjects were enrolled at 9 sites. Twenty-seven subjects underwent follow-up neurodevelopmental assessments 6 months after injury. Greatest depth of visible injury was categorized as scalp, skull, or epidural for 20 subjects, subarachnoid or subdural for 13, cortical for 10, and subcortical for 11. Compared with subjects with more-superficial injuries, subjects with subcortical injuries more frequently had been abused (odds ratio [OR]: 35.6; P < .001), more frequently demonstrated inertial injuries (P < .001), more frequently manifested acute respiratory (OR: 43.9; P < .001) and/or circulatory (OR: 60.0; P < .001) compromise, acute encephalopathy (OR: 28.5; P = .003), prolonged impairments of consciousness (OR: 8.4; P = .002), interhemispheric subdural hemorrhage (OR: 10.1; P = .019), and bilateral brain hypoxia, ischemia, or swelling (OR: 241.6; P < .001), and had lower Mental Developmental Index (P = .006) and Gross Motor Quotient (P < .001) scores 6 months after injury.


CONCLUSIONS
For children <3 years of age, head injury depth is a useful indicator of injury causes and mechanisms.
Hymel
Kent P
KP
Dartmouth-Hitchcock Medical Center, Department of Pediatrics, One Medical Center Dr, Lebanon, NH 03756-0001, USA. kphymel@gmail.com
Stoiko
Michael A
MA
Herman
Bruce E
BE
Combs
Amy
A
Harper
Nancy S
NS
Lowen
Deborah
D
Deye
Katherine P
KP
Homa
Karen
K
Blackman
James A
JA
D000058:Accidental Falls / Q000517:prevention & control; D002649:Child Abuse / Q000517:prevention & control; D002675:Child, Preschool; D006259:Craniocerebral Trauma / Q000145:classification* / Q000175:diagnosis* / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D020197:Head Injuries, Penetrating / Q000145:classification / Q000175:diagnosis / Q000209:etiology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male