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Paediatrics
Research
A retrospective review of paediatric head injuries in Asia – a Pan Asian Trauma Outcomes Study (PATOS) collaboration
  1. Shu-Ling Chong1,2,
  2. Uzma Rahim Khan3,
  3. Indumathy Santhanam4,
  4. Jun Seok Seo5,
  5. Quan Wang6,
  6. Sabariah Faizah Jamaluddin7,
  7. Quoc Ai Hoang Trong8,
  8. Su Yah Chew9,10,
  9. Marcus Eng Hock Ong11,12
  1. 1 Department of Emergency Medicine, KK Women’s and Children’s Hospital, Singapore, Singapore
  2. 2 Duke-NUS Medical School, Singapore
  3. 3 Department of Emergency Medicine, Aga Khan University Hospital, Karachi, Pakistan
  4. 4 Department of Pediatric Emergency Medicine, Institute of Child Health and Hospital for Children, Madras Medical College, Chennai, Tamilnadu, India
  5. 5 Department of Emergency Medicine, Dongguk University Ilsan Hospital, School of Medicine, Dongguk University, Seoul, Republic of Korea
  6. 6 Department of Emergency Medicine, Beijing Children's Hospital, Capital Medical University, Beijing, China
  7. 7 Department of Emergency and Trauma, Sungai Buloh Hospital, Selangor, Malaysia
  8. 8 Department of Emergency, Hue Central Hospital, Hue, Vietnam
  9. 9 Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
  10. 10 Khoo Teck Puat-National Children’s Medical Institute,, National University Health System, Singapore
  11. 11 Department of Emergency Medicine, Singapore General Hospital, Singapore
  12. 12 Health Services and Systems Research, Duke-NUS Medical School, Singapore
  1. Correspondence to Shu-Ling Chong; chong.shu-ling{at}kkh.com.sg

Abstract

Objective We aim to examine the mechanisms of head-injured children presenting to participating centres in the Pan Asian Trauma Outcomes Study (PATOS) and to evaluate the association between mechanism of injury and severe outcomes.

Design and setting We performed a retrospective review of medical records among emergency departments (EDs) of eight PATOS centres, from September 2014 – August 2015.

Participants We included children <16 years old who presented within 24 hours of head injury and were admitted for observation or required a computed tomography (CT) of the brain from the ED. We excluded children with known coagulopathies, neurological co-morbidities or prior neurosurgery. We reviewed the mechanism, intent, location and object involved in each injury, and the patients’ physical findings on presentation.

Outcomes Primary outcomes were death, endotracheal intubation or neurosurgical intervention. Secondary outcomes included hospital and ED length of stay.

Results 1438 children were analysed. 953 children (66.3%) were male and the median age was 5.0 years (IQR 1.0–10.0). Falls predominated especially among children younger than 2 years (82.9%), while road traffic injuries were more likely to occur among children 2 years and above compared with younger children (25.8% vs 11.1%). Centres from upper and lower middle-income countries were more likely to receive head injured children from road traffic collisions compared with those from high-income countries (51.4% and 40.9%, vs 10.9%, p<0.0001) and attended to a greater proportion of children with severe outcomes (58.2% and 28.4%, vs 3.6%, p<0.0001). After adjusting for age, gender, intent of injury and gross national income, traffic injuries (adjusted OR 2.183, 95% CI 1.448 to 3.293) were associated with severe outcomes, as compared with falls.

Conclusions Among children with head injuries, traffic injuries are independently associated with death, endotracheal intubation and neurosurgery. This collaboration among Asian centres holds potential for future prospective childhood injury surveillance.

  • aumatic brain injury
  • child
  • non-accidental Injury
  • neurosurgery

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/bmjopen-2016-015759

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    Footnotes

    • Contributors CSL, URK, IS, and MEHO made substantial contributions to the conception and design of the work. CSL, URK, IS, SJS, WQ, SFJ, HTAQ, and CSY contributed in the data acquisition. CSL, URK, IS, CSY and MEHO contributed in the analysis and interpretation of the data. All authors revised it critically for important intellectual content and approved of the final version to be published.

    • Funding This work was supported by the Singapore SingHealth DUKE-NUS Paediatrics Academic Clinical Programme.

    • Competing interests None declared.

    • Patient consent This is a retrospective study and waiver of informed consent was granted by the Institutional Review Board.

    • Ethics approval Singapore SingHealth Centralised Institutional Review Board (CIRB, E).

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement There is no additional unpublished data from this study available currently.