Pediatric Emergency Department, Hospital Infantil Universitario Niño Jesús, Avenida de Menedez Pelayo 65, 28009, Madrid, Spain.
Pediatric Emergency Department, Hospital Universitario Gregorio Marañón, Madrid, Spain.
Eur J Pediatr. 2022 Aug;181(8):2901-2908. doi: 10.1007/s00431-022-04492-x. Epub 2022 May 12.
Specific knowledge of the features of minor head trauma in infants is necessary to develop appropriate preventive strategies and adjust clinical management in pediatric emergency departments (PEDs). The aim of this study is to describe the epidemiology of minor blunt head trauma in infants < 3 months who present to PEDs. We performed a prospective study of infants evaluated in any of 13 Spanish PEDs within 24 h of a minor head trauma (Glasgow Coma Scale scores of 14-15) between May 2017 and November 2020. Telephone follow-up was conducted for all patients over the 4 weeks after the initial PED visit. Of 1,150,255 visits recorded, 21,981 children (1.9%) sustained a head injury, 386 of whom (0.03%) were under 3 months old. Among the 369 patients who met the inclusion criteria (0.03%), 206 (56.3%) were male. The main causes of trauma were fall-related (298; 80.8%), either from furniture (138/298; 46.3%), strollers (92/298; 30.9%), or a caregiver's arms (61/298; 20.5%). Most infants were asymptomatic (317; 85.9%) and showed no signs of injury on physical exam (210; 56.9%). Imaging studies were performed in 195 patients (52.8%): 37 (10.0%) underwent computed tomography (CT) scan, 162 (43.9%) X-ray, and 22 (6.0%) ultrasound. A clinically important traumatic brain injury (ciTBI) occurred in 1 infant (0.3% overall; 95% CI, 0-1.5), TBI was evidenced on CT scan in 12 (3.3% overall; 95% CI, 1.7-5.7), and 20 infants had an isolated skull fracture (5.5% overall; 95% CI, 3.4-8.3). All outcomes were caused by falls onto hard surfaces.
Most head injuries in infants younger than 3 months are benign, and the rate of ciTBI is low. Prevention strategies should focus on falls onto hard surfaces from furniture, strollers, and caregivers' arms. Optimizing imaging studies should be a priority in this population.
• Infants younger than 3 months are vulnerable to minor blunt head trauma due to their age and to difficulties in assessing the subtle symptoms and minimal physical findings detected on examination. • A low threshold for CT scan is recommended in this population.
• Most cases of blunt head trauma in infants younger than 3 months have good outcomes, and the rate of clinically important traumatic brain injury is low. • Optimizing imaging studies should be a priority in this population, avoiding X-ray examinations and reducing unnecessary CT scans.
描述在西班牙 13 家儿科急诊室（PED）就诊的 <3 个月龄婴儿发生轻微钝性头部创伤的流行病学特征。
我们开展了一项前瞻性研究，纳入了 2017 年 5 月至 2020 年 11 月期间发生轻微头部创伤（格拉斯哥昏迷量表评分为 14-15 分）后 24 小时内在任何一家西班牙 PED 就诊的 1150255 名婴儿，对所有患者在初始 PED 就诊后 4 周进行电话随访。
在记录的 1150255 次就诊中，21981 名（1.9%）儿童发生了头部损伤，其中 386 名（0.03%）年龄在 3 个月以下。在符合纳入标准的 369 名患者（0.03%）中，206 名（56.3%）为男性。主要致伤原因是坠落伤（298 例；80.8%），包括家具坠落（138/298；46.3%）、婴儿车坠落（92/298；30.9%）或照顾者手臂坠落（61/298；20.5%）。大多数婴儿无症状（317 例；85.9%），体格检查未见明显损伤迹象（210 例；56.9%）。195 名患者（52.8%）进行了影像学检查：37 名（10.0%）行 CT 扫描，162 名（43.9%）行 X 线检查，22 名（6.0%）行超声检查。1 名婴儿发生临床相关创伤性脑损伤（ciTBI）（总体发生率 0.3%；95%CI，0-1.5%），12 名（总体发生率 3.3%；95%CI，1.7-5.7%）行 CT 扫描发现 TBI，20 名婴儿发生单纯颅骨骨折（总体发生率 5.5%；95%CI，3.4-8.3%）。所有结局均由坠落在坚硬表面引起。
3 个月龄以下婴儿的头部损伤多数为良性，ciTBI 发生率低。预防策略应侧重于家具、婴儿车和照顾者手臂导致的坠落伤。在该人群中，应优先优化影像学检查。
