Skip to main content

Advertisement

SpringerLink
Log in

The importance of skull impact site for minor mechanism head injury requiring neurosurgical intervention

  • Original Article
  • Published:
Child's Nervous System Aims and scope Submit manuscript

Abstract

Purpose

The most frequent impact sites for head injury patients who require surgical intervention are the temporo-parietal regions. However, most recent guidelines for indication of neuroimaging for head injury sparsely address the impact site as a risk factor. Our purpose was to determine the association between the site of impact in a minor mechanism pediatric head injury and neurosurgical intervention.

Method

A retrospective cohort study of head injury patients seen between 2000 and 2016 in a large trauma center was carried out. We looked at all children ages 0–18 years who underwent neurosurgical intervention for head traumas. A major mechanism was defined as a fall of >1 m, being struck by a fast-flying object, or a motor collision involving an estimated speed of >40 kph. All other mechanisms were classified as minor.

Results

Out of 533 patients, we excluded patients with non-accidental trauma, patients with a relevant chronic illness, patients with a major mechanism of injury, and patients with missing important data, leaving 43 as the study group. Of the 43 patients with a minor mechanism, none had a site of impact that was outside the temporo-parietal region.

Conclusion

We studied one of the largest cohorts of pediatric patients undergoing neurosurgical intervention for a head injury. In our cohort, none of the children who sustained a minor mechanism of injury suffered a site of impact in the occipital or frontal bone regions outside the temple region. These data suggest that injury location should be considered in assessing the need for neuroimaging in minor mechanism head trauma patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Astrand R, Rosenlund C, Undén J (2016) Scandinavian guidelines for initial management of minor and moderate head trauma in children. BMC Med 14:33

    Article  PubMed  PubMed Central  Google Scholar 

  2. Babl FE, Borland ML, Phillips N, Kochar A, Dalton S, McCaskill M, Cheek JA, Gilhotra Y, Furyk J, Neutze J, Lyttle MD, Bressan S, Donath S, Molesworth C, Jachno K, Ward B, Williams A, Baylis A, Crowe L, Oakley E, Dalziel SR, Paediatric Research in Emergency Departments International Collaborative (PREDICT) (2017) Accuracy of PECARN, CATCH, and CHALICE head injury decision rules in children: a prospective cohort study. Lancet 389(10087):2393–2402

    Article  PubMed  Google Scholar 

  3. Blakely TA Jr, Harrington DE (1993) Mild head injury is not always mild; implications for damage litigation. Med Sci Law 33(3):231–242

    Article  PubMed  Google Scholar 

  4. Brenner D, Elliston C, Hall E, Berdon W (2001) Estimated risks of radiation-induced fatal cancer from pediatric CT. AJR Am J Roentgenol 176(2):289–296

    Article  CAS  PubMed  Google Scholar 

  5. Brody AS, Frush DP, Huda W, Brent RL (2007) Radiation risk to children from computed tomography. Pediatric 120(3):677–682

    Article  Google Scholar 

  6. Da Dalt L, Marchi AG, Laudizi L, Crichiutti G, Messi G, Pavanello L et al (2006) Predictors of intracranial injuries in children after blunt head trauma. Eur J Pediatr 165(3):142–148

    Article  PubMed  Google Scholar 

  7. Dunning J, Daly JP, Lomas J-P, Lecky F, Batchelor J, Mackway-Jones K (2006) Derivation of the children’s head injury algorithm for the prediction of important clinical events decision rule for head injury in children. Arch Dis Child 91(11):885–891

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Gallagher JP, Browder EJ (1968) Extradural hematoma, experience with 167 patients. J Neurosurg 29(1):1–12

    Article  CAS  PubMed  Google Scholar 

  9. Greenes DS, Schutzman SA (1998) Occult intracranial injury in infants. Ann Emerg Med 32(6):680–686

    Article  CAS  PubMed  Google Scholar 

  10. Kuppermann N, Holmes JF, Dayan PS, Hoyle JD, Atabaki SM, Holubkov R et al (2009) Identification of children at very low risk of clinically-important brain injuries after head trauma: a prospective cohort study. Lancet 374(9696):1160–1170

    Article  PubMed  Google Scholar 

  11. Mahinda H, Murti O (2009) Variability in thickness of human skull bones and sternum—an autopsy experience. J Forensic Med Toxicol 26(2):26–31

    Google Scholar 

  12. McLaurin RL, Ford LE (1964) Extradural hematoma statistical survey of 47 cases. J Neurosurg 21(5):364–371

    Article  CAS  PubMed  Google Scholar 

  13. NICE guidelines (n.d.). Head injury: assessment and early management. Clinical guideline [CG176] Published date: January 3014. Last updated Sept 2019, https://www.nice.org.uk/guidance/cg176. Accessed 01 Dec 2019

  14. Osmond MH, Klassen TP, Wells GA, Correll R, Jarvis A, Joubert G, Bailey B, Chauvin-Kimoff L, Pusic M, McConnell D, Nijssen-Jordan C, Silver N, Taylor B, Stiell IG, Pediatric Emergency Research Canada (PERC) Head Injury Study Group (2010) CATCH: a clinical decision rule for the use of computed tomography in children with minor head injury. CMAJ 182(4):341–348

    Article  PubMed  PubMed Central  Google Scholar 

  15. Pearce MS, Salotti JA, Little MP, McHugh K, Lee C, Kim KP, Howe NL, Ronckers CM, Rajaraman P, Sir Craft AW, Parker L, Berrington de González A (2012) Radiation exposure from CT scans in childhood and subsequent risk of leukaemia and brain tumours: a retrospective cohort study. Lancet 380(9840):499–505

    Article  PubMed  PubMed Central  Google Scholar 

  16. Rogers AJ, Kuppermann N (2013) Incidental findings in children with blunt head trauma evaluated with cranial CT scans. Pediatrics 132(2):e356–e363

    Article  PubMed  Google Scholar 

  17. Schonfeld D, Bressan S, Da Dalt L, Henien MN, Winnett JA, Nigrovic LE (2014) Pediatric emergency care applied research network head injury clinical prediction rules are reliable in practice. Arch Dis Child 99(5):427–431

    Article  PubMed  Google Scholar 

  18. Schutzman SA, Barnes P, Duhaime AC, Greenes D, Homer C, Jaffe D, Lewis RJ, Luerssen TG, Schunk J (2001) Evaluation and management of children younger than two years old with apparently minor head trauma: proposed guidelines. Pediatrics 107(5):983–993

    Article  CAS  PubMed  Google Scholar 

  19. Schutzman SA, Greenes DS (2001) Pediatric minor head trauma. Ann Emerg Med 37(1):65–74

    Article  CAS  PubMed  Google Scholar 

  20. Smits M (2007) Minor head injury: guidelines for the use of CT—a multicenter validation study. Radiology 245(3):831–838

    Article  PubMed  Google Scholar 

  21. Thiam DW, Yap SH, Chong SL (2015) Clinical decision rules for pediatric minor head injury: are CT scans a necessary evil? Ann Acad Med Singap 44(9):335–341

    PubMed  Google Scholar 

Download references

Acknowledgments

We would like to thank Shiri Diskin, PhD, for her significant editing contribution.

Author information

Authors and Affiliations

  1. Pediatric Emergency Department, Tel Aviv Medical Center, Tel Aviv, Israel

    Oren Tavor

  2. Dana Children’s Hospital, Soraski Medical Center, 6 Weizmann Street, Tel Aviv, Israel

    Oren Tavor

  3. Rainbow Children’s Hospital, Madhapur, Hyderabad, India

    Sirisha Boddu

  4. Pediatric Emergency Department, Dana Children’s Hospital, Tel Aviv Medical Center, University of Tel Aviv, Tel Aviv, Israel

    Miguel Glatstein

  5. Department of Neurosurgery, The Hospital for Sick Children, Toronto, ON, Canada

    Maria Lamberti

  6. Division of Neurosurgery, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada

    Abhaya V. Kulkarni

  7. Division of Pediatric Emergency Medicine, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada

    Dennis Scolnik

  8. Division of Clinical Pharmacology and Toxicology, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada

    Dennis Scolnik

Authors
  1. Oren Tavor
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sirisha Boddu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Miguel Glatstein
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Maria Lamberti
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Abhaya V. Kulkarni
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Dennis Scolnik
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Dr. Tavor had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Glatstein, Kulkarni, Tavor, Scolnik

Acquisition, analysis, or interpretation of data: All authors

Drafting of the manuscript: Tavor, Scolnik

Critical revision of the manuscript for important intellectual content: All authors

Administrative, technical, or material support: Tavor, Boddu, Lamberti

Supervision: Scolnik, Kulkarni

Corresponding author

Correspondence to Oren Tavor.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethics approval

This retrospective chart review study involving human participants was in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The Human Investigation Committee (IRB) of the University of Toronto approved this study.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Tavor, O., Boddu, S., Glatstein, M. et al. The importance of skull impact site for minor mechanism head injury requiring neurosurgical intervention. Childs Nerv Syst 36, 3021–3025 (2020). https://doi.org/10.1007/s00381-020-04612-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00381-020-04612-8

Keywords

Search

Navigation