title: [Children with minor head injury in the emergency department: Is skull radiography necessary for children under 2 years?].
abstract: BACKGROUND
  Current guidelines on the management of mild head trauma (traumatic brain injury/TBI) do not include the presence of a skull fracture in determining the risk of intracranial injury. However, in our setting cranial radiography is still performed frequently to rule out the presence of skull fracture.
  
  
  OBJECTIVE
  To estimate the prevalence of clinically-important traumatic brain injuries (ciTBI) in children younger than two years of age with mild TBI.
  
  
  METHODS
  Descriptive observational study. All children attended in emergency department with mild TBI (Glasgow ≥14 points) for a year were included. We defined ciTBI as intracranial injuries that caused death or required neurosurgery, intubation for more than 24 hours, inotropic drugs or mechanical ventilation.
  
  
  RESULTS
  The study included 854 children, of which 457 (53.5%) were male. The median patient age was 11.0 months (P25-75: 7.5-17.0 months). In 741 cases (86.8%) the mechanism of TBI was a fall. In 438 cases (51.3%) skull radiography was performed. Eleven children (1.3%) had intracranial injury, but none met the criteria for ciTBI (estimated prevalence of ciTBI was 0%; CI 95%: 0%-0.4%).
  
  
  CONCLUSIONS
  Children younger than two years of age with mild TBI have low prevalence of ciTBI. Consequently, it is possible to monitor children younger than two years with a TBI without performing skull radiography.
authors.affiliation: Servicio de Urgencias, Hospital Sant Joan de Déu Barcelona, Esplugues de Llobregat, Barcelona, España.
authors.forename: David
authors.initials: D
authors.lastname: Muñoz-Santanach
authors.affiliation: Servicio de Urgencias, Hospital Sant Joan de Déu Barcelona, Esplugues de Llobregat, Barcelona, España.
authors.forename: Victoria
authors.initials: V
authors.lastname: Trenchs Sainz de la Maza
authors.affiliation: Servicio de Urgencias, Hospital Sant Joan de Déu Barcelona, Esplugues de Llobregat, Barcelona, España.
authors.forename: Elisa
authors.initials: E
authors.lastname: González Forster
authors.affiliation: Servicio de Urgencias, Hospital Sant Joan de Déu Barcelona, Esplugues de Llobregat, Barcelona, España. Electronic address: cluaces@hsjdbcn.org.
authors.forename: Carles
authors.initials: C
authors.lastname: Luaces Cubells
mesh_terms: D001930:Brain Injuries / Q000000981:diagnostic imaging* / Q000453:epidemiology; D006259:Craniocerebral Trauma / Q000000981:diagnostic imaging* / Q000453:epidemiology; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D015995:Prevalence; D011859:Radiography / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012887:Skull Fractures / Q000000981:diagnostic imaging* / Q000453:epidemiology
keywords: Emergency department; Lesión cerebral traumática leve; Mild traumatic brain injury; Paediatrics; Pediatría; Preescolar; Preschool; Radiografía de cráneo; Servicio de urgencias; Skull radiography; Tomografía; Tomography