Il trauma cranico lieve nel bambino. Analisi della casistica di un pronto soccorso pediatrico e proposta di un protocollo di approccio clinico-diagnostico

Controversy still exists as to which clinical parameters indicate complications in children with mild head trauma (HT) and which is the best diagnostic approach to take in these patients. For this reason, we carried out a prospective study on all subjects who, between Jun 1981 and May 1982, were examined in our emergency room for HT, with the aim of: 1) calculating the incidence of mild or moderate HT in children (0-12 years); 2) evaluating distribution by sex, age group, and type of accident; 3) describing clinical evolution and quantifying complications; 4) evaluating the predictivity of clinical and anamnestic data for fractures or neurological damage. The age distribution of the 755 children so studied (461 males and 294 female) showed frequency in the first years of life (0-3) with a peak at 2 years and a constantly decreasing trend later. The most frequent causes of accident were casual falls (28%) and road accidents (13%). 78% of the children were sent home immediately or after a short period of observation: 18% were sent homewithin 24 hours; 3.6% were hospitalized. Only one child underwent a neurosurgical operation for depressed fracture. 1.4% returned to hospital for symptoms connected with the trauma: there were no complications or sequelae. 54% of the patients received head X-rays, with positive findings in 8% (82% linear fractures, 9% diastasized, and 9% depressed). The standardized data for the number of subjects per age group shows great risk for children under 1 year of age. Focal neirological signs were very rare, while hematoma, letharg and vomiting were frequent. For all signs investigated, we evaluated sensitivity, specificity, predictive value, and significance (X2 test). Hematoma and alteration of consciousness turned out to be the most significant parameters for fractures (X2=7.77; p=0.02; X2=9.61; p=0.01). Conclusions: 1) mild HT is frequent (1.5X100 children), but is generally followed by spontaneous and completely favourable evolution; 2) children under 1 year of age with hematoma or alterations of consciousness are at risk as regards fractures; 3) the number of X-rays taken, although lower than that reported in the literature for similar cases, is still excessive in relation to positivity; 4) finding a fracture did not generally influenced treatment, which was based on an overall clinical judgment.