title: A prospective surveillance of paediatric head injuries in Singapore: a dual-centre study.
abstract: OBJECTIVE
  To study the causes of head injuries among the paediatric population in Singapore, and the association between causes and mortality, as well as the need for airway or neurosurgical intervention.
  
  
  METHODS
  This is a prospective observational study utilising data from the trauma surveillance system from January 2011 to March 2015.
  
  
  METHODS
  Paediatric emergency departments (EDs) of KK Women's and Children's Hospital and the National University Health System.
  
  
  METHODS
  We included children aged <16 years presenting to the paediatric EDs with head injuries who required a CT scan, admission for monitoring of persistent symptoms, or who died from the head injury. We excluded children who presented with minor mechanisms and those whose symptoms had spontaneously resolved.
  
  
  METHODS
  Primary composite outcome was defined as death or the need for intubation or neurosurgical intervention. Secondary outcomes included length of hospital stay and type of neurosurgical intervention.
  
  
  RESULTS
  We analysed 1049 children who met the inclusion criteria. The mean age was 6.7 (SD 5.2) years. 260 (24.8%) had a positive finding on CT. 17 (1.6%) children died, 52 (5.0%) required emergency intubation in the ED and 58 (5.5%) underwent neurosurgery. The main causes associated with severe outcomes were motor vehicle crashes (OR 7.2, 95% CI 4.3 to 12.0) and non-accidental trauma (OR 5.8, 95% CI 1.8 to 18.6). This remained statistically significant when we stratified to children aged <2 years and performed a multivariable analysis adjusting for age and location of injury. For motor vehicle crashes, less than half of the children were using restraints.
  
  
  CONCLUSIONS
  Motor vehicle crashes and non-accidental trauma causes are particularly associated with poor outcomes among children with paediatric head injury. Continued vigilance and compliance with injury prevention initiatives and legislature are vital.
authors.affiliation: Department of Emergency Medicine, KK Women's and Children's Hospital, Duke-NUS Medical School, Singapore.
authors.forename: Shu-Ling
authors.initials: SL
authors.lastname: Chong
authors.affiliation: Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore.
authors.forename: Su Yah
authors.initials: SY
authors.lastname: Chew
authors.affiliation: Department of Emergency Medicine, KK Women's and Children's Hospital, Singapore.
authors.forename: Jasmine Xun Yi
authors.initials: JX
authors.lastname: Feng
authors.affiliation: Department of Emergency Medicine, National University Health System, Singapore.
authors.forename: Penny Yun Lin
authors.initials: PY
authors.lastname: Teo
authors.affiliation: Department of Emergency Medicine, National University Health System, Singapore.
authors.forename: Sock Teng
authors.initials: ST
authors.lastname: Chin
authors.affiliation: Department of Emergency Medicine, Singapore General Hospital, Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore.
authors.forename: Nan
authors.initials: N
authors.lastname: Liu
authors.affiliation: Department of Emergency Medicine, Singapore General Hospital, Health Services and Systems Research (HSSR), Duke-NUS Medical School, Singapore.
authors.forename: Marcus Eng Hock
authors.initials: ME
authors.lastname: Ong
mesh_terms: D002648:Child; D006259:Craniocerebral Trauma / Q000453:epidemiology*; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D011446:Prospective Studies; D012846:Singapore / Q000453:epidemiology
keywords: TRAUMA MANAGEMENT; accidents; child