An Audit of the Epidemiology of Head Injury in Children at Dr George Mukhari Academic Hospital, Pretoria, South Africa.

Abstract

Objectives. To calculate the prevalence of head injury in children admitted to a tertiary health institution and to determine the origins of this trauma (accidental vs intentional) and their outcomes. Methods. A retrospective descriptive review of 200 admissions over a 4-year period (July 2014 to November 2018). Results. 96 children (48 % of admissions) with accidental or intentional head injury were classified into two age groups, 0-7 years and 8-18 years.  83.7 % (52/96) boys and 16.7% (44/96) girls, with a male-to-female ratio of 2.1:1, but the difference was not statistically significant (p>0.05).  The hospital prevalence was 13.7%, with younger children more affected than older children. and girls are more victims of intentional HI than boys.  Most children sustained HI at home, during the day, with 57.3% in urban areas vs 41.7% in rural areas and older children were less prone to intentional head injuries because they were heavy, mobile and not easy to be shaken. The causes for accidental HI were falls (51.0%) in their various forms (from bed, height, parents’ hands, fall of the gate) in younger children, and intentional HI (with bricks, stones, sticks, knobkerrie) in older children. Toddlers represented the most assaulted children in 30.2% of cases (29/96) followed by infants (29.2%) and lastly the primary school children (24.0%).  The severity was assessed using the Glasgow Coma Scale, higher with 79.2% mild injuries and 13.5% severe HI in accidental HI, while in intentional injuries, 79.2% had a normal GCS (15/15), 4.2% with GCS:14-13/15, 10.5% with GCS: 12-9/15 and 4% with severe HI (GCS: 8-3/15). Head Ct scan (bone window or brain view) confirmed the diagnosis with open depressed skull fracture (13.5%), skull base fracture (11.5%) and linear skull fracture (10.4%). Closed skull and ping-pong fractures were recorded in only 7.3% and 3.1%, respectively. Surgery was performed in 83.3% for craniectomy or craniotomy, one decompressive craniectomy and one VP Shunt. The outcome was satisfactory, with 81.3% discharged home, despite skull base and parenchymal lesions after falling from different heights. No death was recorded. Conclusion. Head injury is a significant public health problem and in children, it occurs mostly during school holidays or by a lack of parental supervision. Accidental HI affects more boys than girls, with more intentional HI in girls. Overall, the latter is most common in younger children and the former more frequently in older children. Detailed history taking, in addition to the head CT scan (bone window and brain view) findings, ascertain the diagnosis, dictate the best management and lead to a better outcome. Parental or caretaker supervision remains a critical protective factor.