Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
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Traumatic Brain Injury in Children under Age 24 Months : Analysis of Demographic Data, Risk Factors, and Outcomes of Post-traumatic Seizure

  • Yoon, Sang-Youl (Department of Neurosurgery, Kyungpook National University Hospital) ;
  • Choi, Yeon-Ju (Department of Neurosurgery, Kyungpook National University Hospital) ;
  • Park, Seong-Hyun (Department of Neurosurgery, Kyungpook National University Hospital) ;
  • Hwang, Jeong-Hyun (Department of Neurosurgery, Kyungpook National University Hospital) ;
  • Hwang, Sung Kyoo (Department of Neurosurgery, Kyungpook National University Hospital)
  • Received : 2016.07.19
  • Accepted : 2017.03.14
  • Published : 2017.09.01
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Abstract

Objective : Traumatic brain injury (TBI) in children under age 24 months has characteristic features because the brain at this age is rapidly growing and sutures are opened. Moreover, children this age are completely dependent on their parents. We analyzed the demographic data and risk factors for outcomes in TBI patients in this age group to elucidate their clinical characteristics. Methods : We retrospectively reviewed the medical records and radiological films of children under 24 months who were admitted to Kyungpook National University Hospital from January 2004 to December 2013 for TBI. Specifically, we analyzed age, cause of injury, initial Glasgow coma scale (GCS) score, radiological diagnosis, seizure, hydrocephalus, subdural hygroma, and Glasgow outcome scale (GOS) score, and we divided outcomes into good (GOS 4-5) or poor (GOS 1-3). We identified the risk factors for post-traumatic seizure (PTS) and outcomes using univariate and multivariate analyses. Results : The total number of patients was 60, 39 males and 21 females. Most common age group was between 0 to 5 months, and the median age was 6 months. Falls were the most common cause of injury (n=29, 48.3%); among them, 15 were falls from household furniture such as beds and chairs. Ten patients (16.7%) developed PTS, nine in one week; thirty-seven patients (61.7%) had skull fractures. Forty-eight patients had initial GCS scores of 13-15, 8 had scores of 12-8, and 4 had scored 3-7. The diagnoses were as follows : 26 acute subdural hematomas, 8 acute epidural hematomas, 7 focal contusional hemorrhages, 13 subdural hygromas, and 4 traumatic intracerebral hematomas larger than 2 cm in diameter. Among them, two patients underwent craniotomy for hematoma removal. Four patients were victims of child abuse, and all of them had PTS. Fifty-five patients improved to good-to-moderate disability. Child abuse, acute subdural hematoma, and subdural hygroma were risk factors for PTS in univariate analyses. Multivariate analysis found that the salient risk factor for a poor outcome was initial GCS on admission. Conclusion : The most common cause of traumatic head injury in individuals aged less than 24 months was falls, especially from household furniture. Child abuse, moderate to severe TBI, acute subdural hematoma, and subdural hygroma were risk factors for PTS. Most of the patients recovered with good outcomes, and the risk factor for a poor outcome was initial mental status.

Keywords

References

  1. Annegers JF, Coan SP : The risks of epilepsy after traumatic brain injury. Seizure 9 : 453-457, 2000 https://doi.org/10.1053/seiz.2000.0458
  2. Annegers JF, Grabow JD, Groover RV, Laws ER Jr, Elveback LR, Kurland LT : Seizures after head trauma: a population study. Neurology 30(7 Pt 1) : 683-689, 1980 https://doi.org/10.1212/WNL.30.7.683
  3. Annegers JF, Hauser WA, Coan SP, Rocca WA : A population-based study of seizures after traumatic brain injuries. N Engl J Med 338 : 20-24, 1998 https://doi.org/10.1056/NEJM199801013380104
  4. Arndt DH, Lerner JT, Matsumoto JH, Madikians A, Yudovin S, Valino H, et al. : Subclinical early posttraumatic seizures detected by continuous EEG monitoring in a consecutive pediatric cohort. Epilepsia 54 : 1780-1788, 2013 https://doi.org/10.1111/epi.12369
  5. Chang BS, Lowenstein DH; Quality Standards Subcommittee of the American Academy of Neurology : Practice parameter: antiepileptic drug prophylaxis in severe traumatic brain injury: report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 60 : 10-16, 2003 https://doi.org/10.1212/01.WNL.0000031432.05543.14
  6. Chiaretti A, De Benedictis R, Polidori G, Piastra M, Iannelli A, Di Rocco C : Early post-traumatic seizures in children with head injury. Childs Nerv Syst 16 : 862-866, 2000 https://doi.org/10.1007/s003810000368
  7. Desai BT, Whitman S, Coonley-Hoganson R, Coleman TE, Gabriel G, Dell J : Seizures and civilian head injuries. Epilepsia 24 : 289-296, 1983 https://doi.org/10.1111/j.1528-1157.1983.tb04892.x
  8. Duhaime AC, Alario AJ, Lewander WJ, Schut L, Sutton LN, Seidl TS, et al. : Head injury in very young children: mechanisms, injury types, and ophthalmologic findings in 100 hospitalized patients younger than 2 years of age. Pediatrics 90(2 Pt 1) : 179-185, 1992
  9. Duhaime AC, Christian CW, Rorke LB, Zimmerman RA : Nonaccidental head injury in infants--the "shaken-baby syndrome". N Engl J Med 338 : 1822-1829, 1998 https://doi.org/10.1056/NEJM199806183382507
  10. Fakharian E, Mohammadzadeh M, Behdad S, Babamohammadi A, Mirzadeh AS, Mohammadzadeh J : A seven-year study on head injuries in infants, Iran---the changing pattern. Chin J Traumatol 17 : 153-156, 2014
  11. Formisano R, Barba C, Buzzi MG, Newcomb-Fernandez J, Menniti-Ippolito F, Zafonte R, et al. : The impact of prophylactic treatment on post-traumatic epilepsy after severe traumatic brain injury. Brain Inj 21 : 499-504, 2007 https://doi.org/10.1080/02699050701310994
  12. Greenes DS, Schutzman SA : Infants with isolated skull fracture: what are their clinical characteristics, and do they require hospitalization? Ann Emerg Med 30 : 253-259, 1997 https://doi.org/10.1016/S0196-0644(97)70158-6
  13. Hahn YS, Chyung C, Barthel MJ, Bailes J, Flannery AM, McLone DG : Head injuries in children under 36 months of age. Demography and outcome. Childs Nerv Syst 4 : 34-40, 1988
  14. Hahn YS, Fuchs S, Flannery AM, Barthel MJ, McLone DG : Factors influencing posttraumatic seizures in children. Neurosurgery 22 : 864-867, 1988 https://doi.org/10.1227/00006123-198805000-00008
  15. Keenan HT, Runyan DK, Marshall SW, Nocera MA, Merten DF : A population-based comparison of clinical and outcome characteristics of young children with serious inflicted and noninflicted traumatic brain injury. Pediatrics 114 : 633-639, 2004 https://doi.org/10.1542/peds.2003-1020-L
  16. Kieslich M, Jacobi G : Incidence and risk factors of post-traumatic epilepsy in childhood. Lancet 345 : 187, 1995
  17. Kieslich M, Marquardt G, Galow G, Lorenz R, Jacobit G : Neurological and mental outcome after severe head injury in childhood: a long-term follow-up of 318 children. Disabil Rehabil 23 : 665-669, 2001 https://doi.org/10.1080/09638280110043951
  18. Kim JK, Park JY, Cho TH, Kwon TH, Lim DJ, Chung YK, et al. : Clinical features and prognostic factors of head injury in less than two-year-old children. J Korean Neurosurg Soc 27 : 625-631, 1998
  19. Kochanek PM, Carney N, Adelson PD, Ashwal S, Bell MJ, Bratton S, et al. : Guidelines for the acute medical management of severe traumatic brain injury in infants, children, and adolescents--second edition. Pediatr Crit Care Med 13 Suppl 1 : S1-S82, 2012 https://doi.org/10.1097/PCC.0b013e31823f435c
  20. Liesemer K, Bratton SL, Zebrack CM, Brockmeyer D, Statler KD : Early post-traumatic seizures in moderate to severe pediatric traumatic brain injury: rates, risk factors, and clinical features. J Neurotrauma 28 : 755-762, 2011 https://doi.org/10.1089/neu.2010.1518
  21. Ma CY, Xue YJ, Li M, Zhang Y, Li GZ : Sodium valproate for prevention of early posttraumatic seizures. Chin J Traumatol 13 : 293-296, 2010
  22. Mannix R, Monuteaux MC, Schutzman SA, Meehan WP 3rd, Nigrovic LE, Neuman MI : Isolated skull fractures: trends in management in US pediatric emergency departments. Ann Emerg Med 62 : 327-331, 2013 https://doi.org/10.1016/j.annemergmed.2013.02.027
  23. Ostahowski PJ, Kannan N, Wainwright MS, Qiu Q, Mink RB, Groner JI, et al. : Variation in seizure prophylaxis in severe pediatric traumatic brain injury. J Neurosurg Pediatr 18 : 499-506, 2016 https://doi.org/10.3171/2016.4.PEDS1698
  24. Park JT, Chugani HT : Post-traumatic epilepsy in children-experience from a tertiary referral center. Pediatr Neurol 52 : 174-181, 2015 https://doi.org/10.1016/j.pediatrneurol.2014.09.013
  25. Powell EC, Atabaki SM, Wootton-Gorges S, Wisner D, Mahajan P, Glass T, et al. : Isolated linear skull fractures in children with blunt head trauma. Pediatrics 135 : e851-e857, 2015 https://doi.org/10.1542/peds.2014-2858
  26. Quayle KS, Powell EC, Mahajan P, Hoyle JD Jr, Nadel FM, Badawy MK, et al. : Epidemiology of blunt head trauma in children in U.S. emergency departments. N Engl J Med 371 : 1945-1947, 2014 https://doi.org/10.1056/NEJMc1407902
  27. Ratan SK, Kulshreshtha R, Pandey RM : Predictors of posttraumatic convulsions in head-injured children. Pediatr Neurosurg 30 : 127-131, 1999 https://doi.org/10.1159/000028779
  28. Rhine T, Wade SL, Makoroff KL, Cassedy A, Michaud LJ : Clinical predictors of outcome following inflicted traumatic brain injury in children. J Trauma Acute Care Surg 73(4 Suppl 3) : S248-S253, 2012 https://doi.org/10.1097/TA.0b013e31826b0062
  29. Rollins MD, Barnhart DC, Greenberg RA, Scaife ER, Holsti M, Meyers RL, et al. : Neurologically intact children with an isolated skull fracture may be safely discharged after brief observation. J Pediatr Surg 46 : 1342-1346, 2011 https://doi.org/10.1016/j.jpedsurg.2010.12.019

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