Thorsteinsdottir Svana Katla, Thorsteinsdottir Thordis, Gunnarsson Karl F
University of Iceland and Children's Emergency Department, Landspitali University Hospital, Iceland.
Faculty of Nursing, School of Health Sciences, University of Iceland, and Research Institute in Emergency Care, Landspitali University Hospital, Iceland.
Int Emerg Nurs. 2025 Mar;79:101572. doi: 10.1016/j.ienj.2025.101572. Epub 2025 Jan 29.
Traumatic brain injuries (TBI) are common in emergency departments (ED) and may cause long-term negative outcomes but knowledge on how the first assessment of children with TBI may predict outcomes is lacking. This study aimed to expand the knowledge by describing the incidence, visits, causes, and outcomes of TBI in children in Iceland.
A retrospective descriptive data analysis was conducted on electronic medical records of children aged 0-17 that visited Landspitali EDs due to a traumatic head injury in 2010-2021. Cases were based on registered ICD-10 diagnosis and data was collected on demographics, causes, triage, length of stay (LOS), admissions and mortality rates. Descriptive statistics were calculated, and associations of variables tested for significance.
The study sample included 30,014 emergency visits. The majority involved boys (61.21 %) and children under 6 years old (57.99 %, M = 5.98 years). Girls had a significantly lower mean age (5.75 years vs 6.13 years, p < 0.001). The highest incidence was in one-year olds (729 per 100,000) and was on average 310 per 100,000 children of all ages. Total yearly visits decreased throughout the study period (M = 2,501). Emergency Severity Index (ESI) of 4 (50.77 %) was the most common, with 59.6 % of ESI = 1 cases admitted (p < 0.001). The average LOS was 2.2 h and 1.05 % were admitted. Falls (43.62 %) and soft tissue injuries (73.68 %) were the most common, with intracranial injuries (42.57 %) being the most common in ED observations and admissions. Throughout the study period, 30 (0.10 %) died, thereof three within a week post-injury. In total, 26.64 % of children had at least one revisit to the ED with a traumatic head injury.
Children commonly visit EDs due to TBI, mostly with mild injuries but one fourth revisited with a new head injury. There may be groups of children that require specialised follow-up care and assessment to detect and prevent further complications of TBI. Paediatric emergency nurses may be in a key position in identifying children in need of follow-up care. Further research is needed to enhance knowledge of outcomes of TBI in children and to reflect the important role of nurses in paediatric TBI care.
创伤性脑损伤（TBI）在急诊科很常见，可能会导致长期不良后果，但目前缺乏关于如何通过对TBI患儿的首次评估来预测预后的相关知识。本研究旨在通过描述冰岛儿童TBI的发病率、就诊情况、病因和预后，来扩充这方面的知识。
对2010年至2021年因创伤性头部损伤前往冰岛国家大学医院急诊科就诊的0至17岁儿童的电子病历进行回顾性描述性数据分析。病例基于国际疾病分类第十版（ICD - 10）的诊断记录，收集了人口统计学、病因、分诊、住院时间（LOS）、住院情况和死亡率等数据。计算描述性统计量，并检验变量之间的关联是否具有显著性。
研究样本包括30,014次急诊就诊。大多数是男孩（61.21%）和6岁以下儿童（57.99%，平均年龄M = 5.98岁）。女孩的平均年龄显著更低（5.75岁对6.13岁，p < 0.001）。发病率最高的是1岁儿童（每100,000人中有729例），所有年龄段儿童的平均发病率为每100,000人310例。在整个研究期间，每年的就诊总数呈下降趋势（平均M = 2,501次）。最常见的急诊严重程度指数（ESI）为4级（50.77%），ESI = 1级的病例中有59.6%住院（p < 0.001）。平均住院时间为2.2小时，1.05%的患儿住院。跌倒（43.62%）和软组织损伤（73.68%）最为常见，颅内损伤（42.57%）在急诊观察和住院病例中最为常见。在整个研究期间，30例（0.10%）死亡，其中3例在受伤后一周内死亡。总共有26.64%的儿童因创伤性头部损伤至少再次到急诊科就诊。
儿童因TBI经常前往急诊科就诊，大多数为轻伤，但四分之一的患儿因新的头部损伤再次就诊。可能存在需要专门随访护理和评估以检测和预防TBI进一步并发症的儿童群体。儿科急诊护士在识别需要随访护理的儿童方面可能处于关键地位。需要进一步研究以增进对儿童TBI预后的了解，并体现护士在儿科TBI护理中的重要作用。
