Neuropediatrics 2006; 37 - TP57
DOI: 10.1055/s-2006-945650

PITFALLS IN THE CURRENT MANAGEMENT OF TRAUMATIC BRAIN INJURIES IN CHILDREN – THE STOCKHOLM EXPERIENCE

L von Wendt 1, AC Falk 1, B Söderkvist-Klang 1, J Paavonen 1
  • 1Karolinska Institute, Stockholm, Sweden and Dept. of Child Neurology, University of Helsinki, Finland, Helsinki, Finland, Finland

Objectives: By analysing the case histories of all children (0<16 years) who during a 12 months period were referred for traumatic brain injury (all categories) to the pediatric emergency unit it was attempted to find out to which extent the acute management reflected the documented severity of the insult.

Methods: Emergency services for children with acute head injuries are in metropolitan Stockholm (pop. 1,400.000) centralised to the Karolinska Hospital. The records of all children who during a 12 months period were admitted were scrutinized for detailed information on the accident, symptoms signs and early management.

Results: A total of 3168 children visited the emergency departmentent because of a head injury. The overall incidence of head injury was 905 per 100 000 children. The highest incidence, 2366 per 100.000 children was found in the agegroup<18 months. Every second child was sent some without observation or examination and twelve percent were admitted to a hospital ward for further observation. CT scans were used in 13 percent. Documented severity of the case was on a general level not reflected in the early management.

Conclusion: Current recommendations for acute management of head injury in childhood are diverging and rarely evidence based. Generally used tools for the documentation of the state of especially the very young agegroups may not fully appropriate.