[Home falls in infants before walking acquisition]

National characteristics, etiology, and inpatient outcomes of pediatric traumatic brain injury: a KID study

BACKGROUND

Traumatic brain injury (TBI) in pediatric patients is a major burden to public health. Understanding clinical associations with severity and short hospitalization (≤ 1 day length of stay) is needed to better inform management paradigms and optimize triage.

METHODS

A retrospective review of the Kids' Inpatient Database (KID) was performed for all data reported between 2006 and 2012 for TBI patients aged ≤ 20 years. Univariate and multivariate regression analyses were performed to identify predictive factors of trauma severity and short hospitalization.

RESULTS

A total of 220,777 pediatric TBI cases were identified, with the majority of cases being boys (66%) with a mean age of 11.5 years. Mean length of stay was 5.0 days, with 25% discharged within 1 day, and 83% routinely discharged home. In-hospital mortality occurred in 4% of cases. More severe TBI presentations were significantly and independently associated with older age, weekend admissions, hospital transfers, and in patients with chronic conditions and neurological issues (all P < 0.01). There were 38% of admission that were short hospitalizations. Younger age, male gender, less chronic conditions, fall and assault etiologies, and with milder injury severity all significantly and independently predicted greater likelihood of short hospitalization.

CONCLUSIONS

The severity of pediatric TBI admissions to the hospital can be impacted by a number of parameters. Furthermore, there exists a subset of clinical associations for short hospitalization admissions. Proactive identification of these parameters at time of presentation will assist in optimizing the management of pediatric TBI].

[Home and recreational injuries in children under 1year: 10years of experience]

BACKGROUND

There is little research on the prevalence and characteristics of home and recreational injuries in infants under 12months of age. However, domestic accidents result in an average of 50 infant deaths in France every year.

METHODS

A descriptive and retrospective study was conducted, based on data from the permanent investigation on home and recreational injuries in infants under 12months of age (EPAC) published by the Institute for Public Health. Data were collected from 2004 to 2013 in the pediatric emergency department of Le Havre hospital. A global quantitative analysis was carried out, as well as age-group-based analyses (groups of infants of similar age within a specific range of 3months of age).

RESULTS

A total of 3708 infants under 1year of age were victims of home and recreational injuries. The incidence of domestic accidents was found to be an average of one case per day (gender ratio, 1.12). Up to 85% of reported injuries were found to occur in the home. Falls were the leading cause of home accidents or injuries (73% of the total number of reported accidents), 7% of which resulted from a fall from stairs. Children frequently suffered from concussion or contusions (65%). The neck and head were affected in 73% of cases. A higher proportion of foreign body injuries occurred after 6months of age (RR=2.9, p<0.001). The number of hospitalizations decreased with age: 21% of accidents occurred before 3 months of age; 7% occurred between 9 and 11 months of age (RR=0.32, p<0.001). Falling from a changing table accounted for 9% of fall-related hospitalizations.

CONCLUSIONS

This survey characterized for the first time the occurrence of home and recreational injuries in infants under 12months of age in France.

Pediatric skull fractures and intracranial injuries

The determination of plausibility of an injury arising from a fall leading to head trauma is a great challenge especially in young children. The present review is aimed to discuss important developments in the filed of head trauma cases especially in children. We explored various studies pertaining to head trauma injuries in children by exploring mainly PubMed, Google scholar and some library periodicals available in our library. Studies in the recent past explored the head injuries as a result of a low height fall. However, there are great amount of difficulties in assessment of height with certainty that caused head injuries like skull fracture or intracranial injury. Biomechanical thresholds have been estimated for young children for injuries such as skull fracture, but they have not been assessed against the injuries observed in a clinical setting. So, this review discusses current aspects of pediatric head injuries ranging from a minor head injury to a skull fracture. The present review concludes that recording full details of cause of head trauma such as fall height is essential for proper treatment planning and efficient management.