Predictors of skull fracture and intracerebral pathology after pediatric traumatic brain injury.

Objective: The objective of this study is to demographically identify and describe the local pediatric population that presented to the Emergency Department for TBI and their associated outcomes.

Methods: This was an observational cohort study of consecutive Emergency Department patients aged 0-4 years diagnosed as having a TBI as one of their discharge diagnoses, in a level 1 trauma center in Southeastern United States. Main outcome measures included predictors of abnormal head CT scan and hospital admission. Additionally, demographic characteristics, injury patterns and mechanisms of injury are described.

Results: Predictors of abnormal head CT in this pediatric population include younger age, lower pediatric Glasgow Coma Scale (PGCS), mechanism of traffic accident, and the presence of vomiting. Hospital admission was predicted by the presence of an abnormal CT finding or loss of consciousness in this population. In this single center study, younger children (0-2) were less likely to be symptomatic but more likely to have significant abnormal CT findings.

Conclusion: This paper highlights the burden of TBI in infants and toddlers presenting to the emergency department and highlights the differences in presentation of this common complaint. Better understanding of this population will help to form better strategies or to amend current management practices in order to provide more effective treatment to such patients, especially in hospitals lacking the sophisticated pediatric emergency departments.