title: Epidemiology of paediatric minor head injury: Comparison of injury characteristics with Indices of Multiple Deprivation.
abstract: BACKGROUND
  Head injury (HI) is a common presentation to Child Emergency Departments (CEDs), but the actual number of children attending with minor HI is unclear. Most research has focussed on admitted patients, often relying on hospital-coded admission data. We studied the incidence of minor HI presenting to the CED of a major teaching hospital in Coventry and Warwickshire. HI attendances were compared with population data to identify injury patterns relating to deprivation.
  
  
  METHODS
  All CED admissions were screened by the research team, and data on minor head injuries (GCS 13-15) collected prospectively from 1st January until 31st August 2011. Information was collected on demographics, ethnicity, cause and severity of injury, injury location (in or outside the home), other injuries and mode of arrival. Deprivation data were obtained by cross-referencing postcodes with English Indices of Multiple Deprivation (IMD 2010). For comparison, the hospital audit department provided figures for coded head injuries during the same period.
  
  
  RESULTS
  During the 8 month period, hand-searching identified 1747 children with minor HI, aged between 0 and 16 years. Of these 99% had minimal HI (GCS 15 or 'alert'). In the same period, hospital-coded minor HIs numbered only 1081. HIs formed 9% of all CED attendances. Thirteen children returned to the CED with worrying symptoms after discharge home. Approximately 3.4% of the local paediatric population attend the CED with HI per year (3419/100,000 population). Falls accounted for 62% of HIs overall, rising to 77% in children aged 0-5. Most in-home head injuries (81%) were the result of falls (p<0.0001). Significantly more injuries took place inside the home for 0-5 year olds (58%) than for older children (20%) (p<0.0001). Children living in the most deprived areas were more likely to attend the CED with HI (RR: 1.19; CI: 1.06-1.35, p=0.004), and arrive using emergency services (OR: 1.77; CI: 1.30-2.40, p<0.001). There were no significant differences between the deprived and non-deprived groups for location or cause of injury.
  
  
  CONCLUSIONS
  Young children are particularly at risk of HI and parents should be offered information on injury prevention. More children from deprived areas attended with HI and these families may benefit most from targeted interventions.
authors: University of Warwick Medical School, Coventry, UK. Electronic address: c.a.hawley@warwick.ac.uk.
authors: Carol
authors: C
authors: Hawley
authors: James
authors: J
authors: Wilson
authors: Craig
authors: C
authors: Hickson
authors: Sara
authors: S
authors: Mills
authors: Samila
authors: S
authors: Ekeocha
authors: Magdy
authors: M
authors: Sakr
mesh_terms: D000056:Accident Prevention; D000058:Accidental Falls / Q000517:prevention & control* / Q000706:statistics & numerical data; D000063:Accidents, Traffic / Q000517:prevention & control* / Q000706:statistics & numerical data; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D006259:Craniocerebral Trauma / Q000453:epidemiology* / Q000517:prevention & control; D004632:Emergency Medical Services; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006293:Health Promotion; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010290:Parents / Q000193:education*; D010343:Patient Admission; D011159:Population Surveillance; D006113:United Kingdom / Q000453:epidemiology; D014754:Violence / Q000517:prevention & control* / Q000706:statistics & numerical data
keywords: Deprivation; Emergency department; Epidemiology; Head injury; Information; Paediatric; Population; Trauma