Purpose From 11/1/04-10/31/05, there were 1,194 emergency department (ED) visits for closed head trauma in all age groups, accounting for 2.4% of all ED visits that year. Our objective was to describe the pattern of these visits and their outcomes in the school age group of 5-15 years.
Methods A 1-year (11/1/04-10/31/05) retrospective ED chart review is in process, of which a 100-chart representative sample is to be presented in this abstract as preliminary data. The sample represents patient visits from 5 well-distributed months of the year and includes the first 20 patients in the defined age group that presented in each of those months. Data included age, gender, mechanism of head injury, presence of loss of consciousness, symptoms, head imaging results if done, and disposition.
Results Of all of the visits for closed head injury, those in the 5- to 15-year age group varied from 25-54%, but 4/5 months were very close to 50%. The balance was overwhelmingly under 5 years of age. We therefore anticipate a full chart review to include approximately 550 charts. Of the charts reviewed to date, the male:female ratio was 73:27. Seven fell off bikes, with only one patient wearing a helmet. Four fell off other riding toys (go-cart, skateboard), with no helmet worn. Twenty injuries were in the setting of a team sport event. Forty-two injuries resulted from falls. Others resulted from accidental collisions during play, freak accidents such as being hit in the head by a falling box, or fights. Of the 100 patients reviewed, 21 had documented or believed loss of consciousness. The top 3 reported symptoms were headache (45), altered mental status/cognition, meaning sleepiness, disorientation, perseveration, or a component of amnesia (31), and vomiting (19). Other symptoms included visual changes and dizziness. Thirty-nine patients received noncontrast CT studies of the brain; 8 had positive findings including skull fracture and/or intracranial hemorrhage. Of these 8, half had loss of consciousness and half did not. All were neurologically intact. Seven of the 8 were admitted to the hospital. No one with a negative head CT was admitted.
Conclusions Closed head injury is a very common occurrence and reason to seek emergency care. Causes are varied in this very active age group but are likely to be somewhat avoidable by safety measures (such as helmet use). Serious findings of skull or intracranial hemorrhage can be associated with a normal neurological exam, and in this series, the history of loss of consciousness may not be a sensitive indicator of who is at higher risk.
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