Penetrating head injuries in children presenting to the emergency department in Australia and New Zealand: A PREDICT prospective study

Franz E. Babl, Mark D. Lyttle, Silvia Bressan, Meredith L. Borland, Natalie Phillips, Amit Kochar, Sarah Dalton, John A. Cheek, Yuri Gilhotra, Jeremy Furyk, Jocelyn Neutze, Susan Donath, Stephen Hearps, Marta Arpone, Louise Crowe, Stuart R. Dalziel, Ruth Barker, Ed Oakley

Research output: Contribution to journalArticle

Abstract

Aim: Penetrating head injuries (pHIs) are associated with high morbidity and mortality. Data on pHIs in children outside North America are limited. We describe the mechanism of injuries, neuroimaging findings, neurosurgery and mortality for pHIs in Australia and New Zealand. Methods: This was a planned secondary analysis of a prospective observational study of children <18 years who presented with a head injury of any severity at any of 10 predominantly paediatric Australian/New Zealand emergency departments (EDs) between 2011 and 2014. We reviewed all cases where clinicians had clinically suspected pHI as well as all cases of clinically important traumatic brain injuries (death, neurosurgery, intubation >24 h, admission >2 days and abnormal computed tomography). Results: Of 20 137 evaluable patients with a head injury, 21 (0.1%) were identified to have sustained a pHI. All injuries were of non-intentional nature, and there were no gunshot wounds. The mechanisms of injuries varied from falls, animal attack, motor vehicle crashes and impact with objects. Mean Glasgow Coma Scale on ED arrival was 10; 10 (48%) had a history of loss of consciousness, and 7 (33%) children were intubated pre-hospital or in the ED. Fourteen (67%) children underwent neurosurgery, two (10%) craniofacial surgery, and five (24%) were treated conservatively; four (19%) patients died. Conclusions: Paediatric pHIs are very rare in EDs in Australia and New Zealand but are associated with high morbidity and mortality. The absence of firearm-related injuries compared to North America is striking and may reflect Australian and New Zealand firearm regulations.

Original languageEnglish
Pages (from-to)861-865
Number of pages5
JournalJournal of Paediatrics and Child Health
Volume54
Issue number8
DOIs
Publication statusPublished - 1 Aug 2018

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Penetrating Head Injuries
New Zealand
Hospital Emergency Service
Prospective Studies
Wounds and Injuries
Firearms
Neurosurgery
North America
Mortality
Morbidity
Gunshot Wounds
Glasgow Coma Scale
Unconsciousness
Motor Vehicles
Craniocerebral Trauma
Neuroimaging
Observational Studies
Tomography
Pediatrics

Cite this

Babl, Franz E. ; Lyttle, Mark D. ; Bressan, Silvia ; Borland, Meredith L. ; Phillips, Natalie ; Kochar, Amit ; Dalton, Sarah ; Cheek, John A. ; Gilhotra, Yuri ; Furyk, Jeremy ; Neutze, Jocelyn ; Donath, Susan ; Hearps, Stephen ; Arpone, Marta ; Crowe, Louise ; Dalziel, Stuart R. ; Barker, Ruth ; Oakley, Ed. / Penetrating head injuries in children presenting to the emergency department in Australia and New Zealand : A PREDICT prospective study. In: Journal of Paediatrics and Child Health. 2018 ; Vol. 54, No. 8. pp. 861-865.
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abstract = "Aim: Penetrating head injuries (pHIs) are associated with high morbidity and mortality. Data on pHIs in children outside North America are limited. We describe the mechanism of injuries, neuroimaging findings, neurosurgery and mortality for pHIs in Australia and New Zealand. Methods: This was a planned secondary analysis of a prospective observational study of children <18 years who presented with a head injury of any severity at any of 10 predominantly paediatric Australian/New Zealand emergency departments (EDs) between 2011 and 2014. We reviewed all cases where clinicians had clinically suspected pHI as well as all cases of clinically important traumatic brain injuries (death, neurosurgery, intubation >24 h, admission >2 days and abnormal computed tomography). Results: Of 20 137 evaluable patients with a head injury, 21 (0.1{\%}) were identified to have sustained a pHI. All injuries were of non-intentional nature, and there were no gunshot wounds. The mechanisms of injuries varied from falls, animal attack, motor vehicle crashes and impact with objects. Mean Glasgow Coma Scale on ED arrival was 10; 10 (48{\%}) had a history of loss of consciousness, and 7 (33{\%}) children were intubated pre-hospital or in the ED. Fourteen (67{\%}) children underwent neurosurgery, two (10{\%}) craniofacial surgery, and five (24{\%}) were treated conservatively; four (19{\%}) patients died. Conclusions: Paediatric pHIs are very rare in EDs in Australia and New Zealand but are associated with high morbidity and mortality. The absence of firearm-related injuries compared to North America is striking and may reflect Australian and New Zealand firearm regulations.",
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Babl, FE, Lyttle, MD, Bressan, S, Borland, ML, Phillips, N, Kochar, A, Dalton, S, Cheek, JA, Gilhotra, Y, Furyk, J, Neutze, J, Donath, S, Hearps, S, Arpone, M, Crowe, L, Dalziel, SR, Barker, R & Oakley, E 2018, 'Penetrating head injuries in children presenting to the emergency department in Australia and New Zealand: A PREDICT prospective study' Journal of Paediatrics and Child Health, vol. 54, no. 8, pp. 861-865. https://doi.org/10.1111/jpc.13903

Penetrating head injuries in children presenting to the emergency department in Australia and New Zealand : A PREDICT prospective study. / Babl, Franz E.; Lyttle, Mark D.; Bressan, Silvia; Borland, Meredith L.; Phillips, Natalie; Kochar, Amit; Dalton, Sarah; Cheek, John A.; Gilhotra, Yuri; Furyk, Jeremy; Neutze, Jocelyn; Donath, Susan; Hearps, Stephen; Arpone, Marta; Crowe, Louise; Dalziel, Stuart R.; Barker, Ruth; Oakley, Ed.

In: Journal of Paediatrics and Child Health, Vol. 54, No. 8, 01.08.2018, p. 861-865.

Research output: Contribution to journalArticle

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T1 - Penetrating head injuries in children presenting to the emergency department in Australia and New Zealand

T2 - A PREDICT prospective study

AU - Babl, Franz E.

AU - Lyttle, Mark D.

AU - Bressan, Silvia

AU - Borland, Meredith L.

AU - Phillips, Natalie

AU - Kochar, Amit

AU - Dalton, Sarah

AU - Cheek, John A.

AU - Gilhotra, Yuri

AU - Furyk, Jeremy

AU - Neutze, Jocelyn

AU - Donath, Susan

AU - Hearps, Stephen

AU - Arpone, Marta

AU - Crowe, Louise

AU - Dalziel, Stuart R.

AU - Barker, Ruth

AU - Oakley, Ed

PY - 2018/8/1

Y1 - 2018/8/1

N2 - Aim: Penetrating head injuries (pHIs) are associated with high morbidity and mortality. Data on pHIs in children outside North America are limited. We describe the mechanism of injuries, neuroimaging findings, neurosurgery and mortality for pHIs in Australia and New Zealand. Methods: This was a planned secondary analysis of a prospective observational study of children <18 years who presented with a head injury of any severity at any of 10 predominantly paediatric Australian/New Zealand emergency departments (EDs) between 2011 and 2014. We reviewed all cases where clinicians had clinically suspected pHI as well as all cases of clinically important traumatic brain injuries (death, neurosurgery, intubation >24 h, admission >2 days and abnormal computed tomography). Results: Of 20 137 evaluable patients with a head injury, 21 (0.1%) were identified to have sustained a pHI. All injuries were of non-intentional nature, and there were no gunshot wounds. The mechanisms of injuries varied from falls, animal attack, motor vehicle crashes and impact with objects. Mean Glasgow Coma Scale on ED arrival was 10; 10 (48%) had a history of loss of consciousness, and 7 (33%) children were intubated pre-hospital or in the ED. Fourteen (67%) children underwent neurosurgery, two (10%) craniofacial surgery, and five (24%) were treated conservatively; four (19%) patients died. Conclusions: Paediatric pHIs are very rare in EDs in Australia and New Zealand but are associated with high morbidity and mortality. The absence of firearm-related injuries compared to North America is striking and may reflect Australian and New Zealand firearm regulations.

AB - Aim: Penetrating head injuries (pHIs) are associated with high morbidity and mortality. Data on pHIs in children outside North America are limited. We describe the mechanism of injuries, neuroimaging findings, neurosurgery and mortality for pHIs in Australia and New Zealand. Methods: This was a planned secondary analysis of a prospective observational study of children <18 years who presented with a head injury of any severity at any of 10 predominantly paediatric Australian/New Zealand emergency departments (EDs) between 2011 and 2014. We reviewed all cases where clinicians had clinically suspected pHI as well as all cases of clinically important traumatic brain injuries (death, neurosurgery, intubation >24 h, admission >2 days and abnormal computed tomography). Results: Of 20 137 evaluable patients with a head injury, 21 (0.1%) were identified to have sustained a pHI. All injuries were of non-intentional nature, and there were no gunshot wounds. The mechanisms of injuries varied from falls, animal attack, motor vehicle crashes and impact with objects. Mean Glasgow Coma Scale on ED arrival was 10; 10 (48%) had a history of loss of consciousness, and 7 (33%) children were intubated pre-hospital or in the ED. Fourteen (67%) children underwent neurosurgery, two (10%) craniofacial surgery, and five (24%) were treated conservatively; four (19%) patients died. Conclusions: Paediatric pHIs are very rare in EDs in Australia and New Zealand but are associated with high morbidity and mortality. The absence of firearm-related injuries compared to North America is striking and may reflect Australian and New Zealand firearm regulations.

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