The juvenile head trauma syndrome Deterioration after mild TBI: Diagnosis and clinical presentation at the Emergency Department

Angelina R. A. Pikstra, Zwany Metting, Johanna M. Fock, Joukje van der Naalt*

*Corresponding author for this work

    Research output: Contribution to journalArticleAcademicpeer-review

    3 Citations (Scopus)

    Abstract

    Background: Annually 14.000 children with traumatic brain injury (TBI) are admitted to the Emergency Depathuent (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. (C) 2016 European Paediatric Neurology Society. Published by Elsevier Ltd. All rights reserved.

    Original languageEnglish
    Pages (from-to)344-349
    Number of pages6
    JournalEuropean Journal of Paediatric Neurology
    Volume21
    Issue number2
    Early online date23-Sept-2016
    DOIs
    Publication statusPublished - Mar-2017

    Keywords

    • Traumatic brain injury
    • Deterioration
    • Juvenile head trauma syndrome
    • Diagnosis
    • Features
    • Children
    • FAMILIAL HEMIPLEGIC MIGRAINE
    • SPREADING DEPRESSION
    • BRAIN-INJURY
    • DELAYED DETERIORATION
    • COMPUTED-TOMOGRAPHY
    • TRIGGERED MIGRAINE
    • CHILDREN
    • COMA
    • EDEMA

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