Journal of Korean Biological Nursing Science

Korean society of Biological Nursing Science (한국기초간호학회)
권호 표지
DOI QR코드

DOI QR Code

Risk Factors of Intracranial Hemorrhage in Skull Fracture after Pediatric Head Trauma

두부 외상 후 두개골 골절 환아의 두개내 출혈 위험요인

  • Ji, Myoung-Hee (Department of Nursing, Asan Medical Center) ;
  • Choi, Hye-Ran (Department of Clinical Nursing, University of Ulsan College of Medicine)
  • Received : 2020.01.03
  • Accepted : 2020.02.14
  • Published : 2020.02.29
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose: The purpose of this study was to investigate the risk factors of intracranial hemorrhage in children with skull fractures from head trauma. Methods: The retrospective study included 205 patients diagnosed with a skull fracture in a pediatric emergency room. Data were analyzed using 𝓍2-test, Fisher's exact test, t-test, and logistic regression analysis with the SPSS/WIN24.0 program. Results: Intracranial hemorrhage was diagnosed in 71 patients. There were statistically significant differences between the hemorrhagic group and non-hemorrhagic group in age group, places of accident, type of accident, location of the fracture, and symptoms. Intracranial hemorrhage by age group was higher in school-age and adolescence than in infancy. The places of accidents of hemorrhage were higher in street and school than in the home. The types of an accident of bleeding were higher in the case of knock and traffic accident than in fall. Symptoms of nausea, headache, and loss of consciousness were associated with higher intracranial hemorrhage. Multivariable logistic regression analysis showed that knock (OR= 3.29, 95% CI= 1.50-7.22), traffic accident (OR= 4.78, 95% CI= 1.31-17.43), nausea (OR= 4.18, 95% CI= 1.42-12.31), and loss of consciousness (OR= 3.29, 95% CI= 1.41-9.50) were risk factors for intracranial hemorrhage. Conclusion: In this study, the risk factors of intracranial hemorrhage were identified in pediatric patients with skull fractures caused by head trauma. It is recommended that the results of this study be used to manage and educate patients, caregivers, and medical staff after head trauma hemorrhage.

Keywords

References

  1. Tepas JJ 3rd, DiScala C, Ramenofsky ML, Barlow B. Mortality and head injury: the pediatric perspective. Journal of Pediatric Surgery. 1990;25(1):92-96.https://doi.org/10.1016/S0022-3468(05)80170-8
  2. Song KJ. Approach to TBI(traumatic brain injury) with public health model: focusing on CDC [Internet]. Sejong: Korea Centers for Disease Control and Prevention; 2010 [cited 2019 January 26]. Available from: http://www.cdc.go.kr/board.es?mid=a20602010000&bid=0034&act=view&list_no=12430
  3. Anderson T, Heitger M, Macleod AD. Concussion and mild head injury. Practical Neurology. 2006;6(6):342-357. https://doi.org/10.1136/jnnp.2006.106583
  4. Bruce DA. Pediatric head injury. In: Wilkins RH, Rengachary SS, editors. Neurosurgery. 2nd ed. New York, NY: McGraw-Hill; 1996. p.2707-2716.
  5. Berger MS, Pitts LH, Lovely M, Edwards MS, Bartkowski HM. Outcome from severe head injury in children and adolescents. Journal of Neurosurgery. 1985;62(2):194-199. https://doi.org/10.3171/jns.1985.62.2.0194
  6. Arneitz C, Sinzig M, Fasching G. Diagnostic and clinical management of skull fractures in children. Journal of Clinical Imaging Science. 2016;6(47):342-357. http://doi.org/10.4103/2156-7514.194261
  7. Atabaki SM, Stiell IG, Bazarian JJ, Sadow KE, Vu TT, Camarca MA, et al. A clinical decision rule for cranial computed tomography in minor pediatric head trauma. Archives of Pediatrics & Adolescent Medicine. 2008;162(5):439-445. https://doi.org/10.1001/archpedi.162.5.439
  8. Hyun DK, Ha YS, Park CO. A clinical analysis of pediatric head injuries. Journal of Korean Neurosurgical Society. 2001;30(1):54-59.
  9. Erlichman DB, Blumfield E, Rajpathak S, Weiss A. Association between linear skull fractures and intracranial hemorrhage in children with minor head trauma. Pediatric Radiology. 2010;40(8):1375-1379. http://doi.org/10.1007/s00247-010-1555-4
  10. Ko HS, Kim GT, Kang KH. Is routinely repeated brain computed tomography necessary after traumatic brain injury in an emergency setting? Journal of the Korean Society of Emergency Medicine. 2007;18(6):554-562. http://doi. org/10.3340/jkns.2015.58.2.125
  11. Menoch MJ, Hirsh DA, Khan NS, Simon HK, Sturm JJ. Trends in computed tomography utilization in the pediatric emergency department. Pediatrics. 2012;129(3):e690-e697. http://doi.org/10.1542/peds.2011-2548
  12. Kuppermann N, Holmes JF, Dayan PS, Hoyle JD, Atabaki SM, Holubkov R, et al. Identification of children at very low risk of clinically-important brain injuries after head trauma: a prospective cohort study. The Lancet. 2009;374(9696): 1160-1170.http://doi.org/10.1016/S0140-6736(09)61558-0
  13. Pearce MS, Salotti JA, Little MP, McHugh K, Lee C, Kim KP, et al. Radiation exposure from CT scans in childhood and subsequent risk of leukaemia and brain tumours: a retrospective cohort study. The Lancet. 2012;380(9840):499-505. https://doi.org/10.1016/S0140-6736(12)60815-0
  14. Palchak MJ, Holmes JF, Vance CW, Gelber RE, Schauer BA, Harrison MJ, et al. A decision rule for identifying children at low risk for brain injuries after blunt head trauma. Annals of Emergency Medicine. 2003;42(4):492-506. https://doi.org/10.1067/S0196-0644(03)00425-6
  15. Ryu JM, Seo MH, Kim WY, Kim W, Lim KS. A pilot study on environmental factors contributing to childhood home slip-down injuries. Journal of the Korean Society of Traumatology. 2009;22(1):51-56.
  16. Hu CF, Fan HC, Chang CF, Chen SJ. Current approaches to the treatment of head injury in children. Pediatrics & Neonatology. 2013;54(2):73-81. https:// doi.org/10.1016/j.pedneo.2012.12.011
  17. Powell EC, Atabaki SM, Wootton-Gorges S, Wisner D, Mahajan P, Glass T, et al. Isolated linear skull fractures in children with blunt head trauma. Pediatrics. 2015;135(4):e851-e857. http://doi.org/10.1542/peds.2014-2858
  18. Kim GT. Development of clinical criteria for indication of computed tomography (CT) scans in minor head injury patients. Journal of the Korean Society of Emergency Medicine. 2012;23(1):24-32.
  19. Lim YS, Youm SL, Shin JH, Ryoo E, Park CW, Shin JH, et al. Clinical analysis of mild head trauma in children admitted to department of emergency medicine. Journal of the Korean Society of Emergency Medicine. 1999;10(3):456-465.
  20. Schutzman SA, Barnes P, Duhaime AC, Greenes D, Homer C, Jaffe D, et al. Evaluation and management of children younger than two years old with apparently minor head trauma: proposed guidelines. Pediatrics. 2001;107(5):983-993. https://doi.org/10.1542/peds.107.5.983
  21. Kim YS, Lim H, Cho YS, Kim HJ. The relationship between type and size of scalp injury and intracranial injury among patients who visited the emergency room due to head trauma. Journal of the Korean Society of Traumatology. 2006;19(1):8-13.
  22. Nelson EL, Melton JL, Annegers JF, Laws ER, Offord KP. Incidence of skull fractures in Olmsted County, Minnesota. Neurosurgery. 1984;15(3):318-324. https://doi.org/10.1227/00006123-198409000-00005
  23. Trefan L, Houston R, Pearson G, Edwards R, Hyde P, Maconochie I, et al. Epidemiology of children with head injury: a national overview. Archives of Disease in Childhood. 2016;101(6):527-532. http://doi.org/10.1136/archdischild-2015-308424
  24. Jo HJ, Lim YS, Kim JJ, Cho JS, Hyun SY, Yang HJ, et al. Value of repeat brain computed tomography in children with traumatic brain injury. Journal of Trauma and Injury. 2015;28(3):149-157. https://doi.org/10.20408/jti.2015.28.3.149
  25. Kim OR, Park YM, Kim SR. Clinical review on severe brain injury in children. Journal of Kyongbuk Medical School. 1983;24(2):71-76.
  26. Kim KH, Lee KH, Kim WY, Yoon YC, Kim HY. Computed tomography(CT) in head trauma patients with alert mental status: how important are the clinical symptoms. Journal of the Korean Society of Emergency Medicine. 1997;8(4): 564-570.
  27. Choi SW, Son DG, Lee HS. A high-yield clinical variable for brain CT scan in head injured patients. Journal of the Korean Society of Emergency Medicine. 1994;5(2):202-208.
  28. Gruskin KD, Schutzman SA. Head trauma in children younger than 2 years: are there predictors for complications? Archives of Pediatrics & Adolescent Medicine. 1999;153(1):15-20. https://doi.org/10.1001/archpedi.153.1.15

Cited by

  1. 외상성 급성 경막하 혈종 환자의 생존 관련 요인 vol.12, pp.4, 2021, https://doi.org/10.15207/jkcs.2021.12.4.285