Morbidity and mortality in children with traumatic head injuries at the university children's hospital in Damascus

Abstract

Background: Traumatic head injury is an important health problem, a major cause of mortality, morbidity and disability in children; It builds a psychological, social and economic burden not only on individuals, society but also on the health system.

Objectives: Determining general features, mortality rates and causes of morbidity among patients with traumatic head injuries, also determining the results of the provided medical management to develop plans and avoid gaps in the future.

Materials and Methods: A prospective cohort study that includes all admitted patients with a history of head trauma at the University Children's Hospital in Damascus during the period from 1/1/2020 to 31/12/2020. The data were collected in a designed form and analyzed using SPSS v.25, taken Ethical approval from the University Children's Hospital Authority.

Results: The sample consists of 65 patients, 16 of whom needed admission to the intensive care unit (24.6%), the incidence of male injuries was higher (69.2%), and it was found that the most common causes were falls (66.2%). The most exposed ages to accidents are between 5-10 years (40%). Vomiting is the most common symptom (43.1%) in which patients referred to the emergency department. Low awareness was statistically significant in traffic accident patients (p-value=0.033), the severity of all cases was mild (87.27%) according to the Glasgow coma scale in the emergency department. The quarantine period during the COVID-19 pandemic affected the accident injury rate as the incidence of falls increased while the incidence of traffic accidents decreased. Computed tomography is an important diagnostic tool, the most frequent find is skull fractures (76.9%). The length of hospital stay is related to morbidity, the most common of is the neurological cause (89.2%). The overall stay period was more than 7 days (61.5%). Conservative and surgical medical measures were applied during the stay, and their results were good in all 35 cases (53.8%). 28 cases of disability (43.1%), and two deaths following fall accidents (3.1%). The risk factors associated with disability were identified, the most important  in gender was for (males), admission to the care unit (p-value=0.008), clinical symptoms upon admission, which were convulsions (p-value=0.004), decreased consciousness (p-value=0.033), vomiting, imaging radiological, where the presence of fractures, cerebral edema, and hemorrhage were considered risk factors, and hemorrhage was  considered a statistically significant risk factor (p-value=0.047), the medical management provided whether it was pharmacological (sodium chloride pump, steroids, anticonvulsants (p-value=0.008) or surgical (p-value=0.025) or automatic ventilation (p-value=0.027).

Conclusion: Determining the causes of morbidity and outcomes will enable us in the future to avoid gaps in diagnosis and provided managements to patients starting from the scene of the accident, during transportation until arriving at the hospital in order to alleviate the disability caused by these accidents.