Influence of age and fall type on head injuries in infants and toddlers

摘要

Age-based differences in fall type and neuroanatomy in infants and toddlers may affect clinical presentations and injury patterns. Objective: Our goal is to understand the influence of fall type and age on injuries to help guide clinical evaluation. Design/Setting/Participants: Retrospectively, 285 children 0-48. months with accidental head injury from a fall and brain imaging between 2000 and 2006 were categorized by age (infan. ≤ 1 year and toddler = 1-4 years) and fall type: low (≤3. ft), intermediate (>3 and <10. ft), high height falls (≥10. ft) and stair falls. Outcome Measures: Clinical manifestations were noted and head injuries separated into primary (bleeding) and secondary (hypoxia, edema). The influence of age and fall type on head injuries sustained was evaluated. Results: Injury patterns in children <4 years varied with age. Despite similar injury severity scores, infants sustained more skull fractures than toddlers (71% vs. 39%). Of children with skull fractures, 11% had no evidence of scalp/facial soft tissue swelling. Of the patients with primary intracranial injury, 30% had no skull fracture and 8% had neither skull fracture nor cranial soft tissue injury. Low height falls resulted in primary intracranial injury without soft tissue or skull injury in infants (6%) and toddlers (16%). Conclusions: Within a given fall type, age-related differences in injuries exist between infants and toddlers. When interpreting a fall history, clinicians must consider the fall type and influence of age on resulting injury. For young children, intracranial injury is not always accompanied by external manifestations of their injury.