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Head injuries in children under 36 months of age

Demography and outcome

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Abstract

Head injuries in children under the age of 3 years have not been extensively studied, due in part to the lack of an objective tool for neurological assessment. We have developed a Children's Coma Scale (CCS) by modifying the verbal response subscore of the Glasgow Coma Scale (GCS) to overcome this limitation. When applied prospectively to children under 3 years of age, we found the CCS to be useful in predicting outcome. During the 5-year study period from 1981 to 1985, there were 738 patients with head injuries (0–16 years) admitted to the Children's Memorial Hospital in Chicago, including 318 (43.1%) less than 3 years of age. Initial data demonstrated the following observations. The most common mechanism of injury was a fall (75.5%). Although a brief loss of consciousness (LOC) was reported in three-fourths of the patients, prolonged LOC of more than 6 h was uncommon (16/318, 5.0%). The classically described “lucid interval” was seen in only 7 children (2.2%) and was not a reliable indicator of epidural hematoma. Post-traumatic seizures developed more commonly in children under 2 years of age (15.7%) than in older children (11.6% under 3 years of age, 9.6%, entire group), (P<0.001). Oculovestibular reflex and bilateral fixed dilated pupils had the most reliable correlation with outcome. Other brain-stem reflexes were less useful. Intracranial pressure greater than 40 torr in children with CCS scores of 3, 4 or 5 was inevitably fatal; however, 10 of 16 children with ICP less than 40 torr showed a good outcome.

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Authors and Affiliations

  1. Division of Pediatric Neurosurgery, Children's Memorial Hospital, Northwestern University Medical School, 2300 Children's Plaza, 60614, Chicago, IL, USA

    Yoon S. Hahn, Chiehong Chyung, Martha J. Barthel, Julian Bailes, Ann M. Flannery & David G. McLone

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  1. Yoon S. Hahn
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  2. Chiehong Chyung
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  3. Martha J. Barthel
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  4. Julian Bailes
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  5. Ann M. Flannery
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  6. David G. McLone
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Hahn, Y.S., Chyung, C., Barthel, M.J. et al. Head injuries in children under 36 months of age. Child's Nerv Syst 4, 34–39 (1988). https://doi.org/10.1007/BF00274081

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