title: The juvenile head trauma syndrome - Deterioration after mild TBI: Diagnosis and clinical presentation at the Emergency Department.
abstract: BACKGROUND
  Annually 14.000 children with traumatic brain injury (TBI) are admitted to the Emergency Department (ED) in the Netherlands. Presentation varies and a specific entity comprises the juvenile head trauma syndrome (JHTS) with secondary deterioration after a mild trauma. As outcome of JHTS can be fatal, early recognition is essential.
  
  
  OBJECTIVE
  To outline the epidemiology and clinical features of JHTS, in comparison to paediatric mild TBI patients without JHTS.
  
  
  METHODS
  Retrospective study of 570 patients with mild TBI admitted to the ED of a level-one trauma centre from 2008 to 2014. Diagnosis of JHTS by experienced neurologists was compared with diagnosis by physicians at the ED.
  
  
  RESULTS
  Physicians at the ED diagnosed JHTS more frequently (14%) compared to experienced neurologists (8%). JHTS occurred after a lucid interval varying from 5 to 225 min (mean 44 (SD 64)) with changes in consciousness. JHTS patients were younger compared to mild TBI patients (4.1 (SD 2.4) vs. 7.3 (SD 5.7), p < 0.01), (range: 1-10 years). Falls occurred more often in JHTS (84% vs. 69%, p = 0.03) and at presentation, vomiting (42% vs. 22%, p < 0.01) and changed behaviour (29% vs. 1%, p = 0.03) were more present compared to the mild TBI group.
  
  
  CONCLUSIONS
  JHTS occurs more often in children up to 10 years with falls as major cause of injury. Clues for recognition of this syndrome comprise changes in consciousness and vomiting or changed behaviour on presentation at the ED. For clinical practice, these factors should guide the decision for hospital admission or discharge.
authors.affiliation: Department of Neurology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands. Electronic address: a.r.a.pikstra@umcg.nl.
authors.forename: Angelina R A
authors.initials: ARA
authors.lastname: Pikstra
authors.affiliation: Department of Paediatric Neurology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands. Electronic address: z.metting@umcg.nl.
authors.forename: Zwany
authors.initials: Z
authors.lastname: Metting
authors.affiliation: Department of Paediatric Neurology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands. Electronic address: j.m.fock@umcg.nl.
authors.forename: Johanna M
authors.initials: JM
authors.lastname: Fock
authors.affiliation: Department of Neurology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands. Electronic address: j.van.der.naalt@umcg.nl.
authors.forename: Joukje
authors.initials: J
authors.lastname: van der Naalt
mesh_terms: D000367:Age Factors; D000070642:Brain Injuries, Traumatic / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology*; D002648:Child; D002675:Child, Preschool; D003243:Consciousness; D006259:Craniocerebral Trauma / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology*; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D009426:Netherlands / Q000453:epidemiology; D000066553:Problem Behavior; D012189:Retrospective Studies; D013577:Syndrome; D014839:Vomiting / Q000150:complications
keywords: Children; Deterioration; Diagnosis; Features; Juvenile head trauma syndrome; Traumatic brain injury