Research Reports - The juvenile head trauma syndrome - Deterioration after mild TBI

Eur J Paediatr Neurol. 2016 Sep 23. pii: S1090-3798(16)30163-5. doi:
10.1016/j.ejpn.2016.09.005. [Epub ahead of print]

Pikstra AR(1), Metting Z(2), Fock JM(3), van der Naalt J(4).

BACKGROUND: Annually 14.000 children with traumatic brain injury (TBI) are
admitted to the Emergency Department (ED) in the Netherlands. Presentation varies
and a specific entity comprises the juvenile head trauma syndrome (JHTS) with
secondary deterioration after a mild trauma. As outcome of JHTS can be fatal,
early recognition is essential.
AIM: To outline the epidemiology and clinical features of JHTS, in comparison to
paediatric mild TBI patients without JHTS.
METHODS: Retrospective study of 570 patients with mild TBI admitted to the ED of
a level-one trauma centre from 2008 to 2014. Diagnosis of JHTS by experienced
neurologists was compared with diagnosis by physicians at the ED.
RESULTS: Physicians at the ED diagnosed JHTS more frequently (14%) compared to
experienced neurologists (8%). JHTS occurred after a lucid interval varying from
5 to 225 min (mean 44 (SD 64)) with changes in consciousness. JHTS patients were
younger compared to mild TBI patients (4.1 (SD 2.4) vs. 7.3 (SD 5.7), p < 0.01),
(range: 1-10 years). Falls occurred more often in JHTS (84% vs. 69%, p = 0.03)
and at presentation, vomiting (42% vs. 22%, p < 0.01) and changed behaviour (29%
vs. 1%, p = 0.03) were more present compared to the mild TBI group.
CONCLUSION AND DISCUSSION: JHTS occurs more often in children up to 10 years with
falls as major cause of injury. Clues for recognition of this syndrome comprise
changes in consciousness and vomiting or changed behaviour on presentation at the
ED. For clinical practice, these factors should guide the decision for hospital
admission or discharge. 

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