Clinical Indicators of Traumatic Brain Injury and Skull Fracture in Pediatric Head Trauma Patients

Murat ÖZSARAÇ; Özgür KARCIOĞLU; Hakan TOPAÇOĞLU; Cüneyt AYRIK; Selahattin KIYAN; Serkan SENER; Serhat GÜMRÜKÇÜ; Yücel DEMİRAL; Hatice ULUER

Murat ÖZSARAÇ¹, Özgür KARCIOĞLU², Hakan TOPAÇOĞLU³, Cüneyt AYRIK⁴, Selahattin KIYAN¹, Serkan SENER⁵, Serhat GÜMRÜKÇÜ⁶, Yücel DEMİRAL⁷, Hatice ULUER⁸

¹Ege University, Department Of Emergency Medicine, İzmir
²Acıbadem University, Department Of Emergency Medicine, İstanbul
³Dokuz Eylul University, Department Of Emergency Medicine, İzmir
⁴Mersin University Department Of Emergency Medicine, Mersin
⁵Acibadem Hospital, Department Of Emergency Medicine, Bursa
⁶Dokuz Eylul University, School Of Medicine Phase Vı Student, İzmir
⁷Dokuz Eylul University, Department Of Public Health, İzmir
⁸Ege University, Biostatistics And Medical Informatics, İzmir

Keywords: Computed tomography, head injuries, physical examination, skull fracture, traumatic brain injury

Abstract

Background: To determine whether clinical signs and symptoms of brain injury are sensitive indicators of traumatic brain injury (TBI) and skull fracture (SF) in pediatric patients admitted with head trauma.
Methods: A retrospective cross-sectional analysis of all patients younger than 17 years of age admitted to the university-based pediatric Emergency Department (ED) with the complaint of head trauma during a 7-year period was conducted. All children who were admitted into pediatric emergency department had a TBI and/or SF were included in the study.
Results: 1167 patients with the chief complaint of head trauma were admitted to pediatric emergency department during the study period. Of these, 984 subjects were excluded because they had no acute radiographic abnormalities noted or had inadequate records of symptoms. The remaining 183 subjects constituted the study sample. Isolated TBI without SF was found in 40 (21.9%) patients, whereas isolated SF was found in 82 (44.8%) patients, and both TBI and SF were found in 61 (33.3%) patients. Forty five (44.6%) of the patients who had TBI were conscious, with GCS of 15 and had no focal neurological abnormalities. The most common mechanism of head injury was >5- feet fall. Findings that were not significantly associated with TBI were vomiting, post-traumatic seizure, lethargy, irritability, and scalp hematoma without loss of consciousness (LOC) (p=0.044). There was a significantly higher incidence of scalp hematoma (p=0.015) and LOC (p=0.052) in children with SF.
Conclusion: Our results support that seizure, vomiting, lethargy, scalp hematoma, irritability and LOC are insensitive clinical predictors of TBI. LOC appear to be a risk predictor of TBI for patients of only those younger than 2 years old. Scalp hematoma is a potential risk factor for SF.