Pediatric Cranioencephalic Trauma in Senegal: A Consideration of 164 Cases

Abstract

The cranioencephalic trauma (CET) is a worldwide public health problem. This study is aims to evaluate the epidemiologic, clinical, paraclinical, and types of treatment of CET in Senegalese children. The study includes children younger than 15 years, victims of CET from January 2008 to December 2012. The series included 164 patients. The average age was 4.96 years, with a sex ratio of 2.72. Patients were transported by unequipped medical ambulance and 65.8% of the case was discharged within the first 6 hours out of the 79.3%. Two causes of accidents were noted: domestic accident (DA) 56.6%, and road traffic accident (RTA) 29.9%. The initial loss of consciousness (ILC), vomiting, and seizures were reported in 49.5, 33.3, and 17.2% cases, respectively. The initial Glasgow Coma Scale (GCS) score was between 13 and 15 in 65.2%, and between 3 and 8 in 16.5% of the cases. The CT scan revealed that 38.1% of the injuries affected the bone whereas 34.75% were normal. Biologically, there was anemia in 51.2% of the cases and electrolyte imbalance in 16.46%. All patients received medical treatment. Surgery was performed in 21 (12.8%) of the patients. The short-term evaluation results were marked by early mortality in three (1.29%) cases. Pediatric CET is dominated by DAs accounting for a significant sequelae. A significant proportion of clinically benign CET patients shows significant lesions on CT scan. Prevention must be the priority.

Keywords

child - head trauma - surgery

• References

• 1 Sharples PM, Storey A, Aynsley-Green A, Eyre JA. Avoidable factors contributing to death of children with head injury. BMJ 1990; 300 (6717) 87-91
• 2 National Center for Injury Prevention and Control. injury statistics query and reporting system. http://www.cdc.gov/ [cited 2014 Oct 28 ] http://webappa.cdc.gov/sasweb/ncipc/leadcaus10.html
• 3 Adelson PD. Hypothermia following pediatric traumatic brain injury. J Neurotrauma 2009; 26 (3) 429-436
• 4 Langlois JA, Rutland-Brown W, Wald MM. The epidemiology and impact of traumatic brain injury: a brief overview. J Head Trauma Rehabil 2006; 21 (5) 375-378
• 5 Jennett B. Epidemiology of head injury. Arch Dis Child 1998; 78 (5) 403-406
• 6 Tsai WC, Chiu WT, Chiou HY, Choy CS, Hung CC, Tsai SH. Pediatric traumatic brain injuries in Taiwan: an 8-year study. J Clin Neurosci 2004; 11 (2) 126-129
• 7 Shudy M, de Almeida ML, Ly S , et al. Impact of pediatric critical illness and injury on families: a systematic literature review. Pediatrics 2006; 118 (Suppl. 03) S203-S218
• 8 Hawkins ER, Brice JH, Overby BA. Welcome to the world: findings from an emergency medical services pediatric injury prevention program. Pediatr Emerg Care 2007; 23 (11) 790-795
• 9 Kim HB, Kim K, Kwak YH , et al. Epidemiology of traumatic head injury in Korean children. J Korean Med Sci 2012; 27 (4) 437-442
• 10 Hu CF, Fan HC, Chang CF, Chen SJ. Current approaches to the treatment of head injury in children. Pediatr Neonatol 2013; 54 (2) 73-81
• 11 Kraus JF, Fife D, Cox P, Ramstein K, Conroy C. Incidence, severity, and external causes of pediatric brain injury. Am J Dis Child 1986; 140 (7) 687-693
• 12 Alexiou GA, Sfakianos G, Prodromou N. Pediatric head trauma. J Emerg Trauma Shock 2011; 4 (3) 403-408
• 13 Adirim TA, Wright JL, Lee E, Lomax TA, Chamberlain JM. Injury surveillance in a pediatric emergency department. Am J Emerg Med 1999; 17 (6) 499-503
• 14 Sharples PM, Storey A, Aynsley-Green A, Eyre JA. Causes of fatal accidents impliquant childhood head injury in Northern Region. BMJ 1979; 301: 1193-1197
• 15 Brown FD, Brown J, Beattie TF. Why do children vomit after minor head injury?. J Accid Emerg Med 2000; 17 (4) 268-271
• 16 Ando S, Otani M, Moritake K. Clinical analysis of post-traumatic vomiting. Acta Neurochir (Wien) 1992; 119 (1–4) 97-100
• 17 Lawes INC. The origin of the vomiting response: a neuroanatomical hypothesis. Can J Physiol Pharmacol 1990; 68 (2) 254-259
• 18 Jan MM, Camfield PR, Gordon K, Camfield CS. Vomiting after mild head injury. J Pediatr 1997; 130: 134-137
• 19 Abdul Rahman YS, Al Den AS, Maull KI. Prospective study of validity of neurologic signs in predicting positive cranial computed tomography following minor head trauma. Prehosp Disaster Med 2010; 25 (1) 59-62
• 20 Saadat S, Ghodsi SM, Naieni KH , et al. Prediction of intracranial computed tomography findings in patients with minor head injury by using logistic regression. J Neurosurg 2009; 111 (4) 688-694
• 21 National Center for Injury Prevention and Control Traumatic brain injury in the United States: (2014). Assessing outcomes in children. http://www.cdc.gov/traumaticbraininjury/ assessing_ outcomes_in_children. html
• 22 Williamson LM, Morrison A, Stone DH. Trends in head injury mortality among 0–14 year olds in Scotland (1986–95). J Epidemiol Community Health 2002; 56 (4) 285-288
• 23 Masters SJ, McClean PM, Arcarese JS , et al. Skull x-ray examinations after head trauma. Recommendations by a multidisciplinary panel and validation study. N Engl J Med 1987; 316 (2) 84-91
• 24 Master SJ, McClean PM, Arcarese JS , et al; Pediatric Emergency Research Canada (PERC) Head Injury Study Group. CATCH: a clinical decision rule for the use of computed tomography in children with minor head injury. CMAJ 2010; 182 (4) 341-348
• 25 Ciurea AV, Gorgan MR, Tascu A, Sandu AM, Rizea RE. Traumatic brain injury in infants and toddlers, 0–3 years old. J Med Life 2011; 4 (3) 234-243
• 26 King MA, Kanal KM, Relyea-Chew A, Bittles M, Vavilala MS, Hollingworth W. Radiation exposure from pediatric head CT: a bi-institutional study. Pediatr Radiol 2009; 39 (10) 1059-1065
• 27 Brenner DJ, Hall EJ. Computed tomography—an increasing source of radiation exposure. N Engl J Med 2007; 357 (22) 2277-2284
• 28 Ibrahim NG, Wood J, Margulies SS, Christian CW. Influence of age and fall type on head injuries in infants and toddlers. Int J Dev Neurosci 2012; 30 (3) 201-206
• 29 Zygun DA, Steiner LA, Johnston AJ , et al. Hyperglycemia and brain tissue pH after traumatic brain injury. Neurosurgery 2004; 55 (4) 877-881 , discussion 882
• 30 Sharma D, Jelacic J, Chennuri R, Chaiwat O, Chandler W, Vavilala MS. Incidence and risk factors for perioperative hyperglycemia in children with traumatic brain injury. Anesth Analg 2009; 108 (1) 81-89
• 31 Cochran A, Scaife ER, Hansen KW, Downey EC. Hyperglycemia and outcomes from pediatric traumatic brain injury. J Trauma 2003; 55 (6) 1035-1038
• 32 Hall P, Adami HO, Trichopoulos D , et al. Effect of low doses of ionising radiation in infancy on cognitive function in adulthood: Swedish population based cohort study. BMJ 2004; 328 (7430) 19
• 33 Laupacis A, Sekar N, Stiell IG. Clinical prediction rules. A review and suggested modifications of methodological standards. JAMA 1997; 277 (6) 488-494
• 34 Fridriksson T, Kini N, Walsh-Kelly C, Hennes H. Serum neuron-specific enolase as a predictor of intracranial lesions in children with head trauma: a pilot study. Acad Emerg Med 2000; 7 (7) 816-820
• 35 Dunning J, Daly JP, Lomas J-P, Lecky F, Batchelor J, Mackway-Jones K ; Children's head injury algorithm for the prediction of important clinical events study group. Derivation of the children's head injury algorithm for the prediction of important clinical events decision rule for head injury in children. Arch Dis Child 2006; 91 (11) 885-891