This week’s issue of the New England Journal of Medicine features an article that highlights an unprecedented analysis of the nation’s childhood head injuries. The study, authored by physicians at UC Davis School of Medicine and Washington University School of Medicine, analyzed more than 43,000 children who were evaluated for head trauma at 25 emergency departments around the United States. In the accompanying supplements, detailed information about these children, their presentations and results will be useful to doctors and helpful to policy makers seeking potential priorities for public-health interventions such as new guidance on the use of bicycle helmets and automobile safety-seat restraints.
“From an enormous nationwide study of head-injured children, we have distilled a wide range of important features of epidemiology, mechanisms, diagnoses and treatments regarding the full spectrum of blunt head trauma in children,” said Kimberly Quayle, professor of pediatrics at Washington University in St. Louis and medical director of emergency services at St. Louis Children's Hospital. “The findings may be useful in developing injury-prevention measures, such as bike-helmet campaigns, as well as helping guide physicians to make better decisions based on strong evidence.”
With traumatic brain injury being the leading cause of death and disability in children older than 1 year of age, gathering data from hospitals around the country offered helpful insights to the researchers, including how the injuries occurred, the severity of the injuries based on the mechanisms of injury and age group, radiological findings, and neurosurgical interventions performed.
“The detailed information from this very large prospective study is not available from any other source,” said Nathan Kuppermann, professor and chair of emergency medicine at UC Davis who was the lead investigator of the study and senior author of the research letter. “It is a gold mine of information, providing the detailed description of the full breadth of pediatric head injuries.”
The data indicate that falls were the most frequent cause of injury in children younger than 12, while older children more often had head injuries due to assaults, sports activities and motor-vehicle crashes. Among those involved in car crashes, only two-thirds were wearing seat belts. The researchers also found that among children who came to the emergency department suffering head injuries from bicycle collisions, fewer than 20 percent were wearing bicycle helmets.
The data were compiled in 25 emergency departments across the country in a prospective, observational study conducted through the Pediatric Emergency Care Applied Research Network (PECARN) from 2004 through 2006. The study was designed to derive and validate a “prediction rule” or algorithm for predicting clinically important traumatic brain injury in children with minor head trauma. The rule helps physicians in emergency departments assess whether a child presenting with head trauma is likely to have an injury that requires surgical intervention and CT scanning. CT scans carry a small but a non-negligible risk of cancer; the rule is designed to help in decision making and to avoid unnecessary scans.
The research letter, titled “Epidemiology of blunt head trauma in children in U.S. emergency departments,” provides information about the full breadth of head injury severity in children. It also provides data of interest to radiologists and neurosurgeons, with detailed information on CT findings and needed surgical interventions according to age as well as mental status when the pediatric patients presented to the emergency department.
The original study from which these data were compiled was titled, “Identification of children at very low risk of clinically-important brain injuries after head trauma: a prospective cohort study,” and was published in the Lancet in 2009. Kuppermann was the principal investigator and lead author of the study.
In addition to Kuppermann and Quayle, James Holmes, a professor and specialist in emergency medicine at UC Davis, also co-authored the research letter, which appears in the November 13, 2014 issue of the journal.
Their work was supported by grants from the Health Resources and Services Administration/ Maternal and Child Health Bureau, Division of Research, Training and Education and the Emergency Medical Services of Children Program.