353 - Epidemiology of minor head trauma in infants younger than 3 months

Poster Number: 353
Publication Number: 353.205

José Antonio Alonso Cadenas, Pediatric Emergency Department, Niño Jesús Children University Hospital, Madrid, Madrid, Spain; Clara Ferrero García-Loygorri, HOSPITAL GENERAL UNIVERSITARIO GREGORIO MARAÑÓN, Madrid, Madrid, Spain; Rosa María Calderón Checa, University hospital 12 Octubre Madrid, Madrid, Madrid, Spain; Isabel Duran Hidalgo, Hospital Universitario Málaga, Málaga, Andalucia, Spain; Maria Jose Pérez-García, Department of Pediatrics, Hospital Puerta de Hierro Majadahonda, Majadahonda, Madrid, Spain; Pablo Delgado Gómez, Servico de Urgencias - Hospital Infantil Virgen del Rocío, Sevilla, Andalucia, Spain; Rubén Moreno Sánchez, Hospital Universitario del Tajo, Madrid, Madrid, Spain; Miguel Antoñón Rodríguez, University of Salamanca, Valladolid, Castilla y Leon, Spain; Raquel Jiménez García, NIÑO JESUS CHILDREN´S HOSPITAL, MADRID, Madrid, Spain

Background: Minor blunt head trauma occurs frequently and is a major cause of Pediatric Emergency Department (PED) visits. Knowledge of the epidemiology in the youngest infants is important for targeted age specific head injury prevention.

Objective: To describe the epidemiology of infants younger than 3 months with minor head trauma attended at the PED.

Design/Methods: A prospective study was conducted on infants < 3 months old who presented to 13 Spanish PED within 24 hours of a minor head trauma (Glasgow Coma Scale 14-15), between May 2017 and November 2020). All infants were followed up in the next four weeks by a telephone call. Severe mechanism of injury was defined as falls of more than 3 feet or head struck by a high-impact object. A descriptive analysis of the demographics, injury mechanism, radiological findings and outcomes are provided.

Results: During the study period, 1,150,225 patients were attended in the PED, 21,981 (1.9%) had minor blunt head trauma and 369 (0.03%) were younger than 3 months old with complete data, 209 (56.6%) were male. Median age was 49.3 days (IQR 29.4 to 69.3 days).
Causes of minor blunt head trauma are shown in table 1. Most of the falls (255/295, 86.4%) were on a hard surface. Only 22.5% (83/369) had a severe mechanism of injury. There were three cases of non-accidental head injuries (0.8%). Most of infants were asymptomatic (317, 85.9%).Vomiting (20, 5.4%) and sleepiness (36, 9.8%) were the most frequent symptoms. The majority had no signs on physical exam 210 (56.9%), 107 (29.0%) had a head/face erythema/laceration, 74 (20.1%) a scalp hematoma and 33 (8.9%) a GCS of 14. None experienced a loss of consciousness or tense fontanelle.
Imaging tests were performed in 195 (52.8%): 37 (10.0%) underwent a CT scan, 162 (43.9%) a skull radiograph and 22 (6.0%) an ultrasound. Among the asymptomatic infants with no findings on examination, 102 (27.6%) had imaging test of the head.
Traumatic brain injury (TBI) on CT occurred in 12 (3.3% overall, 95% CI 1.7-5.7), all of them had associated skull fracture, and 20 (5.5% overall, 95% CI 3.4-8.3) had isolated skull fracture. One patient (0.3% overall, 95% CI 0-1.5) had clinically important TBI. All injuries were caused by falls on a hard surface.Conclusion(s): Targeted age specific head injury prevention in infants under 3 months with minor blunt head trauma should focus on falls from static devices and strollers. Although clinically important traumatic brain injuries are very infrequent more than half infants undergo radiological tests, only 10% undergo a CT scan. Optimizing radiological tests should be a priority in this population.
Table 1. Causes of minor head blunt trauma.1Bed, changing table, cot, sofa, hammock.