Occult Intracranial Injury in Infants☆,☆☆,★
Section snippets
INTRODUCTION
Several authors recommend using clinical symptoms and signs as a screen for determining which patients need radiographic imaging after head trauma.1, 2, 3, 4, 5, 6, 7, 8, 9, 10 For several reasons, however, many of these recommendations specifically exclude infants younger than 2 years of age.1, 2, 11 First, it has been recognized that infants are at increased risk of intracranial injury (ICI), and that infants may suffer ICI even after more minor mechanisms of injury.1, 12 Second, some authors
MATERIALS AND METHODS
We performed a retrospective analysis of all patients younger than 2 years of age admitted to Children’s Hospital in Boston with an acute ICI between January 1, 1990, and June 30, 1996. Patients were identified through a search of the hospital’s medical records database. Initially, all patients younger than 2 years of age with a discharge diagnosis indicating any form of head injury were identified. The medical record was reviewed for each of these patients, and all patients who had an acute
RESULTS
Three hundred fifty-seven subjects younger than 2 years of age were admitted to Children’s Hospital with a discharge diagnosis related to head trauma over the study period. Of these, 182 subjects were excluded because they had skull fracture but no intracranial injury. Another 74 subjects were excluded because they had no acute radiographic abnormalities noted, or because they had preexisting intracranial lesions or bleeding diathesis. The remaining 101 subjects constituted the study sample
DISCUSSION
We found clinical signs and symptoms to be insensitive indicators of ICI in infants admitted after head injury; only 81% of the infants in our sample had any of the symptoms or signs we studied. Occult ICIs were most common among the youngest infants, with 27% of the infants younger than 6 months of age being asymptomatic.
These findings suggest that infants need to be evaluated in a different manner than older children or adults after head trauma. Increasingly in recent years, researchers have
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Cited by (0)
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From the Division of Emergency Medicine, Department of Pediatrics, Children’s Hospital, Harvard Medical School, Boston, MA.
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Address for reprints: David S Greenes, MD, Emergency Department, Children’s Hospital,300 Longwood Avenue, Boston, MA 02115; 617-355-6624, fax 617-355-6625,E-mail [email protected].
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