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J Paediatr Child Health. 2018 Aug;54(8):861-865. doi: 10.1111/jpc.13903. Epub 2018 Mar 26.

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

Author information

1
Emergency Department, Royal Children's Hospital, Melbourne, Victoria, Australia.
2
Emergency Research Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.
3
Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia.
4
Emergency Department, Bristol Children's Hospital, Bristol, United Kingdom.
5
Academic Department of Emergency Care, University of the West of England, Bristol, United Kingdom.
6
Department of Women's and Children's Health, University of Padova, Padova, Italy.
7
Emergency Department, Princess Margaret Hospital for Children, Perth, Western Australia, Australia.
8
School of Medicine, University of Western Australia, Perth, Western Australia, Australia.
9
Emergency Department, Lady Cilento Children's Hospital, Brisbane, Queensland, Australia.
10
Child Health Research Centre, School of Medicine, University of Queensland, Brisbane, Queensland, Australia.
11
Emergency Department, Women's and Children's Hospital, Adelaide, South Australia, Australia.
12
Emergency Department, Children's Hospital at Westmead, Sydney, New South Wales, Australia.
13
Emergency Department, Monash Medical Centre, Melbourne, Victoria, Australia.
14
Emergency Department, Townsville Hospital, Townsville, Queensland, Australia.
15
Emergency Department, Kidzfirst Middlemore Hospital, Auckland, New Zealand.
16
Emergency Department, Starship Children's Health, Auckland, New Zealand.
17
Liggins Institute, University of Auckland, Auckland, New Zealand.
18
Queensland Injury Surveillance Unit, Brisbane, Queensland, Australia.

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.

KEYWORDS:

Australia; New Zealand; child; firearm injuries; head injury

PMID:
29579354
DOI:
10.1111/jpc.13903

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