Head injures in children : Incidence, sequele and informational needs

Detta är en avhandling från Stockholm : Karolinska Institutet, Department of Women's and Children's Health

Sammanfattning: The aim is to describe head injury characteristics, assessments, classification and occurrence of head injury symptoms, post head injury symptoms and informational needs among children in the age-group 0-15.9 years and information provided to their families. Participants were 3,168 children (0-15.9 years) with a head injury, who visited an Emergency Department during one year. Of these children, various samples were included in the different articles. The design was a cross-sectional with a follow-up at three months after the incident. Methods were: Review of the documented initial diagnosis, symptoms and management at the hospital and questionnaires (Rivermead postconcussion questionnaire (RPQ), Rivermead head injury follow-up questionnaire (RHFUQ), Karolinska postconcussion questionnaire (KPCQ) and a questionnaire about the perception of given information which included one open-ended item) at three month months post injury. Different statistical methods were used in the analysis of the quantitative items and content analyse was used in for the open-ended question. The Results showed that the annual incidence of head injury was 865 /100,000 children with the highest incidence among children less than 18 month of age (2379/100,000). The most frequent external cause of injury was falls (68%) followed by road and traffic accidents (9%). Fifty percent of all children were observed for some time in the Emergency Department and 12 percent were admitted for further observation. CT scans were performed in 13 percent of the children with 108 positive findings. Very few children required neurosurgical intervention. No connection was found between the documented signs and symptoms and management in the hospital. The Scandinavian Head Injury Classification (SHIC) more accurately reflected management in the hospital than the ICD-10 discharge diagnosis. Some differences could be seen in the documented initial symptoms between children of different ages. In one percent of all children a planned followup appointment was documented. A follow-up three months post-injury showed that 35 percent of the children/parents reported postconcussion symptoms. In the analysis of the documented initial symptoms and the prediction of post-concussion symptoms no such predictors could be identified. The three month post-injury follow-up also showed that the children/parents mostly understood the information that was provided and 69 percent did get the information they needed. There were however, some differences between the age groups. The information they needed was expressed as the need for head injury information concerning symptoms and observations as well as the need for emotional support. In conclusion the incidence of head injuries among children is high in the youngest age group. The methods for assessment and documentation of signs and symptoms do not seem to be helpful in clinical decision making. The initial and late symptoms differ by age-group. No conclusive risk factor was found to be predictive of complications. Informational needs are not always met during the visit at the Emergency Department and there seems to be a need for a structured follow-up for children, independent of the severity of head injury.

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